Online Application Online Application Contact InformationCamper Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Parents' Primary Phone*Parents' Secondary PhoneParents' Text #*Parents' Email* Campers' Email Personal InformationName of Parent (s)*Camper Date of Birth*Grade in the Fall of 2021*Sex*MaleFemalePlease describe any special needs, medications, etc. you haveCamp InformationDate of Camp*Choose DateJuly 17-30, 2021Departure/Return Location*Choose LocationJeffersonton, VAWarrenton, VAHaymarket, VALeesburg, VAFrederick, MDHarrisburg, PAWilliamsport, PAPainted Post / Corning, NYMount Morris, NYBuffalo, NYNiagara, OntarioBurlington/Hamilton, OntarioOakville, OntarioToronto, OntarioBarrie, OntarioAirport - Buffalo, NYAirport - Toronto, OntarioAirport - Sudbury, OntarioUnsure at this timeHow did you originally find out about TASC?*Select SourceFriendInternet SearchInternet AdvertisementCamp ConsultantCamp FairNewspaperMagazineOtherInsurance InformationHealth Insurance CompanyPolicy NumberCheck if you do not have health insurance I do not have health insurance Parent/Guardian AuthorizationBy checking below, I hereby give my permission for my son to participate in this camp. I understand that TASC cannot be responsible for theft or damage to personal property, or injury. I certify that my child is normally healthy and is physically able to participate. Any allergies, medications, or special needs have been noted on this form. In case of emergency, the senior staff member has my permission to secure any emergency medical care deemed necessary by a licensed physician. I agree to the Cancellation Policy on the TASC website.Must be checked by parent or legal guardian*I GIVE my authorizationI DO NOT GIVE my authorizationCamper AgreementBy checking below, I agree to abide by the policies of TASC and to cooperate with the leadership of the trip for the benefit of all. TASC sees no place for alcohol or drugs of any kind on any of its activities. If a participant does not follow this policy, TASC reserves the right to demand that the parents immediately provide for his transportation back home.Must be checked by camper*I read and I ACCEPT the Camper AgreementI DO NOT ACCEPT the Camper AgreementPayment MethodSelect payment method*Mailing FULL PAYMENT - check, money order, cashier's checkMailing DEPOSIT -check, money order, cashier's checkCharging FULL PAYMENT to my credit cardCharging DEPOSIT, PAYMENT OR BALANCE to my credit cardAfter you click "Send Application" below you will see a link to the payment page where you can make a secure online payment using your credit card or PayPal account.