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Camp Oz Application
Camper Name
*
Title
First
Middle
Last
Suffix
Address
*
Street Address
Address Line 2
City
State / Province
Postal / Zip Code
Canada
United Kingdom
United States
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Email
*
Phone
*
###
-
###
-
####
Age during Camp (June 2012)
Gender of Camper
Male
Female
Parent(s) Name
Additional Information
Please send me:
Scholarship Information
What is your relationship to epilepsy? (please mark all that apply)
I have epilepsy
My child has epilepsy
My spouse/partner has epilepsy
Another family member has epilepsy
I work with people with epilepsy
Other
Total:
$
0.00
Added to Cart
Thank you for applying to Camp Oz 2012. We will contact you if your application is accepted and send you a parent packet with more information. AFTER you are accepted, you can pay online using the "returning camper" link.
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