Dream Far Foundation Lee County Youth Camp

Dream Far Foundation Lee County Youth Camp

Dream Far Foundation Youth Camp Registration

Lee County
Program Sponsor by

Manifest your locs Win and Son services

Gjulien@dreamfarfoundation.org

www.dreamfarfoundation.org
Youth Information
Last Name
First Name
M.I.
Birth Date

MonthDayYear
Gender
Ethnicity
Email Address
Grade
Current Residence Information
Street Address
Street Address Line 2
City
State
Zip Code
Home Phone Number
Cell Phone Number
Parent/Guardian Information (if different from above)
Name

First NameLast Name
Street Address
Street Address Line 2
City
State
Zip Code

Emergency Contact 1
Last Name
First Name
Primary Phone Number
Physician and Medical Information
Doctor Name
Primary Phone Number
Secondary Phone Number
Preferred Hospital
Insurance/Health Coverage (Company)
Please list any of the following: Current medications, Medication allergies, Food allergies, Chronic health concerns.
www.dreamfarfoundation.org

Enrollment Payment
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DFF Youth Camp enrollment $75.00
Youth Camp registration fee is $75 from July 5th - July 28th (Saturday & Sunday not included) 9am - 2:30pm. Meal will be provided

Total $0.00
Notes
Please inform us of any other vital information you think we may need to know in the event of an emergency. Thank you.
www.dreamfarfoundation.org
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Payment Methods

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