Berwick Boys Foundation
Prospective Boy Information

                                              

First Name

Last Name
            Parent/Guardian
            Boy
 
Boy's Age    (Must be 13 during this Summer)          Boy's Date of Birth   (mm/dd/yyyy)
 
Address to send information to: Street  
City      State   Zip
          Country (non US only)
Phone Numbers:     Home   
   Work 
Email Address:
 
Where did you hear about us?
 
Boy's School  Class Placement  Guidance Counselor
   
Has he ever been away from home before?    How Long?
   
Comments/Questions?