KARE FAMILY CAMP APPLICATION

KARE FAMILY CAMP REGISTRATION
Name of Family*
Name of Oldest Child in KYL*
KYL Member ID of oldest child in KYL
Please enter your 5 digit KYL Member ID if known. Leave blank if unknown.
Please select a camp date*
Saturday, June 10 - Sunday, June 11 is now full.
Type of Camp
Please enter your Immediate Family Members

These are people in your IMMEDIATE family (mom, dad, son, daughter, etc.) This does not include grandma, grandpa, uncles, aunts, cousins, friends, etc.
Contact Name - Parent 1*

First NameLast Name
Parent 2

First NameLast Name
Contact Phone*

Area CodePhone Number
Contact Email*

Confirmation EmailPlease confirm your email in the second box
Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
How Many Babies (Age 0-2)
No Charge for Babies
Baby 1*

First NameLast Name
Baby 2*

First NameLast Name
Baby 3*

First NameLast Name
Baby 4*

First NameLast Name
How many Children (Ages 3-12)
Child 1*

First NameLast Name
Age*
Child 2*

First NameLast Name
Age*
Child 3*

First NameLast Name
Age*
Child 4*

First NameLast Name
Age*
Child 5*

First NameLast Name
Age*
Child 6*

First NameLast Name
Age*
Adult Children (Ages 13 and over)
Adult Child 1*

First NameLast Name
Adult Child 2*

First NameLast Name
Adult Child 3*

First NameLast Name
Adult Child 4*

First NameLast Name
Adult Child 5*

First NameLast Name
Adult Child 6*

First NameLast Name
Extended Family Members

This includes grandparents, or other family members currently living in YOUR home. They must be in the SAME household. Other relatives living OUTSIDE your household need to fill out their own registration.
How many extended family members would like to attend
Extended Family Member1*

First NameLast Name
Relation*
Extended Family Member2*

First NameLast Name
Relation*
Extended Family Member3*

First NameLast Name
Relation*
Extended Family Member4*

First NameLast Name
Relation*
Extended Family Member5*

First NameLast Name
Relation*
Extended Family Member6*

First NameLast Name
Relation*
Additional Information
Does anyone in your family have food allergies or dietary restrictions? If yes, please explain:
Does anyone in your family have medical or physical restrictions/needs? If yes, please explain:
Is there any other information about your family that you would like us to know?
Pricing
Child Price
Age 3-12
Adult Price
Age > 12
> 5 Price
Ext Family Price
# Children
Age 3-12
# Adults
Age >12
# > 5
# Extended Family
Family Price
Total Cost
Item Key
Customer Key

Amount Due

USD

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Should be Empty:

KARE FAMILY CAMP REGISTRATION

Please enter your Immediate Family Members

Extended Family Members

Additional Information

Pricing