Mullins Camp APPLICATION

To apply to Mullins Camp, please complete the form below. A deposit of $750 is due with the application.

* Camper's First Name

* Camper's Last Name

* Birth Date

* Present Grade

* T-Shirt size (adult size) Small Medium Large X-Large

* Address 1

* City

* State

* Zip

* Country

* Phone

* Email Address

* Who should receive information and forms for this camper: Mother & Father Mother Only Father Only Other

* Mother's Salutation Mrs. Ms. Dr.

* Mother's First Name

* Mother's Last Name

* Father's Salutation Mr. Dr.

* Father's First Name

* Father's Last Name

* 2 Week Sessions ($1,750)

Rookie Sessions ($250)

2-Week Session 1: June 19 - July 2

2-Week Session 2: July 3 - July 16

Rookie Session 1: June 19 - June 21

Rookie Session 2: July 3 - July 5

If you prefer to provide your credit card information by phone, please call our office at (800) 869-8228.

The applicant and parent/guardian understand, accept and agree to abide by the rules, regulations, policies, and guidelines as set forth by Mullins Camp. The parent/guardian understands that the applicant is not accepted for the course until they have received written notice of acceptance and have completed all required forms including but not limited to this application, a deposit of $750, proof of medical insurance, a health form, and release and assumption of risk form.

* I understand and agree to the above statement. I am a parent/guardian of the applicant.

Yes

No

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