Summer Registration Form

A.R.C.H Performing Arts Summer Camp

Mystyk Room, 20 E. 112th St, Chicago, Illinois
Athlete Information
Child’s name

First NameLast Name
Birth Date

MonthDayYear
Grade
Gender
Child’s name

First NameLast Name
Grade
Birth Date

MonthDayYear
Gender
Child’s name

First NameLast Name
Grade
Birth Date

MonthDayYear
Gender
Parent/Guardian Information
Name

First NameLast Name
Home Number

Area CodePhone Number
Cell Number

Area CodePhone Number
E-mail
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number

Area CodePhone Number
Alt. Phone Number

Area CodePhone Number
Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Signature
Should be Empty:

A.R.C.H Performing Arts Summer Camp