CAMPER INFO
NAME:
GRADE:	(as of Sept. 2025)
GENDER:	MALE FEMALE
AGE:	(as of Sept. 2025)
EMAIL:
HOME INFO
STREET:
CITY:
STATE:	ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY
ZIPCODE:
PARENT/GUARDIAN NAME:
PARENT'S CELL #:
SCHOOL ATTENDING IN SEPTEMBER:
CAMP DATES (2025)
JUNE 23 - 26 ($240)	JUNE 30 & JULY 1 ($120)
T-Shirt
SIZE:	Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL

Submit

PLEASE SEND CHECKS TO:

JEFF JASPER

PASCACK VALLEY HIGH SCHOOL

200 PIERMONT AVE

HILLSDALE NJ, 07642