Camper Registration Form 

Please fill out a separate form for each camper.

Camper Name *
Camper Name
Address *
Emergency Contact
Parent Name *
Parent Name
Parent or Legal Guardian
Second Parent Name *
Second Parent Name
Parent or Legal Guardian
Phone *
Second Parent Phone
Second Parent Phone
Camp Dates *
select one
T-Shirt Size *
Please choose one
Payment Option *
Please select one

Camper Payment

You have two choices of payment, you can pay via credit card online through this  Payment Link or mail your check, made payable to:  Blackbird Wellness VT 


Blackbird Wellness VT

PO Box 842

Morrisville, VT 05661


Additional questions please contact us at or 802.730.0630