First, if you were referred to the camp by a camp specialist or a past or current professor, please tell us about them by checking the box below and filling in the fields that appear.

I want to provide referrer information.

Referrer's name: *

Referrer's phone number: *

Referrer's e-mail address: *

Referrer's place of employment: *

Next, please tell us a little bit about yourself. All fields are required unless otherwise noted.

First name: *

Last name: *

Address (line 1): *

Address (line 2) (optional):

City: *

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Phone number: *

E-mail address: *

Enter it again to confirm: *

Age: *

Gender: Please select Male Female *

Profession (optional):

Previous experience: (500 chars left) *

Please answer the following questions regarding your attendance and arrival at Camp Abilities Brockport 2012. All fields are required unless otherwise noted.

Are you volunteering for credit? Please select Yes No *

At what college or university are you receiving credit for volunteering at Camp Abilities Brockport? *

Who is your supervising professor? *

Do you need transportation to and/or from the airport or train station? Please select Yes No *

Please provide transportation details: (500 chars left) *

Why are you interested in volunteering at Camp Abilities Brockport? (500 chars left) *

Finally, please answer the following quick questions and then press "Register" to submit the form. All fields are required unless otherwise noted.

Would you like to stay informed about new additions, updates, and enhancements to this site? Please select Yes No *

Would you like to create an account on this site so you can use all of the great members-only features? Please select Yes No *

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Finally, please select a profile picture to use as your account's avatar. *

I verify that the information I've entered into this form is correct and accurate to the best of my knowledge. *