Member Name:

Parent/Guardian Name:

Address:   

City:         

State:           Zip:

Phone:        

E-mail:      

UA Number:

Child's Name, Age, Birthdate, Sex
Camp Konocti is unable to accept any child who is not seven (7) years old on or before June 12, 2022. Parents may be asked for verification of their child’s age if questions arise.

Please click on the Camp Konocti session which your child will be attending:

Session 1 - 7 & 8 Years old - June 9-22

Session 2 - 9 & 10 Years old - June 23-July 6  

Session 3 - 11 & 12 years old - July 7-20 

Session 4 - 13 & 14 years old - July 21-August 3  

  I certify that I am the legal parent, grandparent or guardian of the above-names child,
              and that he/she has my permission to attend Camp Konocti

Enter the text shown in the image above.