Camp High Rocks Camper Application Form

If you would like to register for father-son weekends, please go to this link: Father-Son Weekends.
Current Photo (optional): (JPEG format only)
Camper's First Name:
Camper's Middle Name:
Camper's Last Name:
Camper's Preferred Name:
Parental correspondence
should be addressed to:
Home Address:
City:
State:
Zip Code:
Home Phone:
Preferred Email:
(for correspondence)
Billing Email:
Mother's Information
First Name:
Last Name:
Business Phone:
Cell Phone:
Email Address:
Occupation:
Father's Information
First Name:
Last Name:
Business Phone:
Cell Phone:
Email Address:
Occupation:

2020 Dates and Rates

* Grade denotes 2019-2020 school year.

3-Weeks $5,575 
Sunday, June 7 - Friday, June 26
Grades: 1st - 10th
4 Weeks $6,850 
Monday, June 29 - Saturday, July 25
Grades: 3rd - 10th
Mini I $4,075 
Monday, June 29 - Saturday, July 11
Grades: 2nd - 4th
Mini II $4,075 
Monday, July 13 - Saturday, July 25
Grades: 2nd - 4th
2 Weeks $4,075 
Monday, July 27 - Saturday, August 8
Grades: 1st - 7th
Birthdate:
(mm/dd/yyyy)
Brothers names and ages:
Sisters names and ages:
Do any sisters attend a North Carolina Camp?
If so, which camp?
Would you like information on area girls' camps?
Name of School:
Grade completed by June of 2020:
How did you learn of High Rocks?
Camps attended previously:
Years:
My son requests to be in a cabin with:
My son requests to NOT be in a cabin with:

Personal Information

What would you like for us to help your son accomplish during his stay at High Rocks?

Please list any medical or emotional conditions (i.e., enuresis, sleepwalking, ADD or ADHD, anaphylaxis, asthma), which would require special medical attention or added attention from our staff.

Does your son take prescription medication during the school year?
Will he continue them at camp?
Please list and explain:

Please list any food allergies or dietary restrictions. (We are able to make some accommodations for dietary restrictions and allergies. Please contact us for more information about our food and kitchen capabilities.)

Does your son have any learning disabilities? Explain:

Would you like to recommend friends to High Rocks

Name:
Email:
Address:
City, State, Zip:
Phone Number:
Son's Name:
Son's Age:

Name:
Email:
Address:
City, State, Zip:
Phone Number:
Son's Name:
Son's Age:

Type the word "Yes" in this box to confirm you have read and agree to
Acknowledgement of Risk and the Terms and Conditons Page.