Registration form

Summer Camp Registration Form

Child's Name
First Last
Birthday
Date Format: MM slash DD slash YYYY
Age During Camp
Parent / Guardian
First Last
Address
Street Address City State / Province / Region ZIP / Postal Code
Cell Phone
Work Phone
Home Phone
Emergency Contact (other than parent)
First Last
Emergency Contact Phone Number
Allergies*
If "YES", please list below.
- Yes
- No
List Allergies
Medications currently taking