Silver Lake Confidential Camper Profile

Camper Information
Please complete and submit a separate form for each child
First Name
Last Name
Session	July AugustFull Summer
Mother Email Address
Father Email Address
Camper Email Address
Birthday	Month Select... 123456789101112 Day Select... 12345678910111213141516171819202122232425262728293031 Year Select... 199019911992199319941995199619971998199920002001200220032004200520062007200820092010
Age:
Current grade:
Gender:	Male Female
Number of Summers Completed at Chipinaw	012345678910
Name of current school:
Legal guardian of camper	Select... Mother and FatherMotherFatherOther
Other legal guardian relationship:
Does child live with both parents?	Yes No
If no, with whom?
Are parents divorced?	Yes No
T-Shirt Size	Select... Youth SmallYouth MediumYouth LargeYouth Extra LargeAdult SmallAdult MediumAdult LargeAdult Extra Large

Camp Experience
Prior camp experience and results
Is the camper enthusiastic about coming to camp?
Does the camper have any fears we should know about, such as darkness, swimming, etc.?
Would you like your child to lose, gain or maintain their weight?	Select... MaintainLoseGain
What mealtime problems should we anticipate and how should we deal with them ? (eating peculiarities, special diet, food allergies)
What physical symptoms does your child display before the onset of illness?
Are there any precautions (allergies, physical disabilities, bed wetting, attention deficit problems, etc.) which the camp should be aware of?
If your child's bar or bat mitzvah is scheduled for the fall of 2010 and they are in need of semi - private review sessions, please check this box.
Moms and Dads: In the space provided below please write a personal note to your child's counselors. The counselors will read this section several days before your child arrives at camp. This is your chance to give them information you feel they should know to make your child's camp experience successful. This section is optional and should be kept short and to the point; just the facts please.
Please include any additional confidential information.

Activity Information
List top 3 favorite activities:	List 3 activities you would like to improve your skills:	List 3 activities you would like to try for the first time:
Select... Horseback RidingMountain BikingMountain BoardingNatureRopes CourseSkate Park CeramicsCookingCreative CraftsFine ArtsJewelry - MetalJewelry - BeadedLeather ShopMagicModel RailroadNeedle CraftPhotographyRocketrySculptureSilkscreenStained GlassTotem PolesWoodworking CartooningComputersDigital PhotoRadioVideo AerobicsArcheryBaseballBasketballFencingFootballGolfGymnasticsHockeyLacrosseMartial ArtsPing PongSoccerSoftballSpinningSports FitnessTennisVolleyballWeight Training CircusDanceTheater SailingSwim InstructionTubingWater Skiing	Select... Horseback RidingMountain BikingMountain BoardingNatureRopes CourseSkate Park CeramicsCookingCreative CraftsFine ArtsJewelry - MetalJewelry - BeadedLeather ShopMagicModel RailroadNeedle CraftPhotographyRocketrySculptureSilkscreenStained GlassTotem PolesWoodworking CartooningComputersDigital PhotoRadioVideo AerobicsArcheryBaseballBasketballFencingFootballGolfGymnasticsHockeyLacrosseMartial ArtsPing PongSoccerSoftballSpinningSports FitnessTennisVolleyballWeight Training CircusDanceTheater SailingSwim InstructionTubingWater Skiing	Select... Horseback RidingMountain BikingMountain BoardingNatureRopes CourseSkate Park CeramicsCookingCreative CraftsFine ArtsJewelry - MetalJewelry - BeadedLeather ShopMagicModel RailroadNeedle CraftPhotographyRocketrySculptureSilkscreenStained GlassTotem PolesWoodworking CartooningComputersDigital PhotoRadioVideo AerobicsArcheryBaseballBasketballFencingFootballGolfGymnasticsHockeyLacrosseMartial ArtsPing PongSoccerSoftballSpinningSports FitnessTennisVolleyballWeight Training CircusDanceTheater SailingSwim InstructionTubingWater Skiing
Select... Horseback RidingMountain BikingMountain BoardingNatureRopes CourseSkate Park CeramicsCookingCreative CraftsFine ArtsJewelry - MetalJewelry - BeadedLeather ShopMagicModel RailroadNeedle CraftPhotographyRocketrySculptureSilkscreenStained GlassTotem PolesWoodworking CartooningComputersDigital PhotoRadioVideo AerobicsArcheryBaseballBasketballFencingFootballGolfGymnasticsHockeyLacrosseMartial ArtsPing PongSoccerSoftballSpinningSports FitnessTennisVolleyballWeight Training CircusDanceTheater SailingSwim InstructionTubingWater Skiing	Select... Horseback RidingMountain BikingMountain BoardingNatureRopes CourseSkate Park CeramicsCookingCreative CraftsFine ArtsJewelry - MetalJewelry - BeadedLeather ShopMagicModel RailroadNeedle CraftPhotographyRocketrySculptureSilkscreenStained GlassTotem PolesWoodworking CartooningComputersDigital PhotoRadioVideo AerobicsArcheryBaseballBasketballFencingFootballGolfGymnasticsHockeyLacrosseMartial ArtsPing PongSoccerSoftballSpinningSports FitnessTennisVolleyballWeight Training CircusDanceTheater SailingSwim InstructionTubingWater Skiing	Select... Horseback RidingMountain BikingMountain BoardingNatureRopes CourseSkate Park CeramicsCookingCreative CraftsFine ArtsJewelry - MetalJewelry - BeadedLeather ShopMagicModel RailroadNeedle CraftPhotographyRocketrySculptureSilkscreenStained GlassTotem PolesWoodworking CartooningComputersDigital PhotoRadioVideo AerobicsArcheryBaseballBasketballFencingFootballGolfGymnasticsHockeyLacrosseMartial ArtsPing PongSoccerSoftballSpinningSports FitnessTennisVolleyballWeight Training CircusDanceTheater SailingSwim InstructionTubingWater Skiing
Select... Horseback RidingMountain BikingMountain BoardingNatureRopes CourseSkate Park CeramicsCookingCreative CraftsFine ArtsJewelry - MetalJewelry - BeadedLeather ShopMagicModel RailroadNeedle CraftPhotographyRocketrySculptureSilkscreenStained GlassTotem PolesWoodworking CartooningComputersDigital PhotoRadioVideo AerobicsArcheryBaseballBasketballFencingFootballGolfGymnasticsHockeyLacrosseMartial ArtsPing PongSoccerSoftballSpinningSports FitnessTennisVolleyballWeight Training CircusDanceTheater SailingSwim InstructionTubingWater Skiing	Select... Horseback RidingMountain BikingMountain BoardingNatureRopes CourseSkate Park CeramicsCookingCreative CraftsFine ArtsJewelry - MetalJewelry - BeadedLeather ShopMagicModel RailroadNeedle CraftPhotographyRocketrySculptureSilkscreenStained GlassTotem PolesWoodworking CartooningComputersDigital PhotoRadioVideo AerobicsArcheryBaseballBasketballFencingFootballGolfGymnasticsHockeyLacrosseMartial ArtsPing PongSoccerSoftballSpinningSports FitnessTennisVolleyballWeight Training CircusDanceTheater SailingSwim InstructionTubingWater Skiing	Select... Horseback RidingMountain BikingMountain BoardingNatureRopes CourseSkate Park CeramicsCookingCreative CraftsFine ArtsJewelry - MetalJewelry - BeadedLeather ShopMagicModel RailroadNeedle CraftPhotographyRocketrySculptureSilkscreenStained GlassTotem PolesWoodworking CartooningComputersDigital PhotoRadioVideo AerobicsArcheryBaseballBasketballFencingFootballGolfGymnasticsHockeyLacrosseMartial ArtsPing PongSoccerSoftballSpinningSports FitnessTennisVolleyballWeight Training CircusDanceTheater SailingSwim InstructionTubingWater Skiing

"Mutual" Bunk Placement Request
Please Note: All special requests must be in writing.
What suggestions do you have to assist in proper bunk placement?
List maximum of 2 friends you would like to bunk with (We will do our best to honor mutual requests). Please do not request bed placement as these requests will not be honored.	1. 2.
Upload a Photo of Camper. (Must be a .jpg file, and no more that 10 MB in size.)
Choose a .jpg image file: