Application for Enrollment

When you submit this form the completed information will be emailed to 49er Camp.

As soon as you click submit after completing this form, the results will be displayed for you to print. You will need to print the page and mail it along with your waiver(s) and payment.

* = Required Field

Emergency Contact Emergency Contact Name * Emergency Contact Phone *

Child's Information Child's Name * Boy Girl

Date of Birth: Month Day Year *

Parent's Information Name *

Address Street * City * Zip Code

2008-09 CSULB Athletic Foundation Member Yes No

CSULB Faculty/Employee Yes No If yes, what department are you in? If yes, what is your position?

Please choose a Sesson in which to enroll your child Session 1 (Session Closed) Session 2 only: 7/20 - 8/14
Please remember to submit another separate application if enrolling for both sessions

Placement Procedures

If you would like your camper to be placed with a friend, each friend's full name and age must be submitted with this application prior to June 8th for 1st Session, or prior to July 6th for 2nd Session. FYI Tax ID # 95-610-6694

Friend #1

Name

Age Years Months