Camper's Name:
*
Emergency Contact Information
First Contact: Name
*
Relationship:
*
Phone Number
*
-
Area Code
Phone Number
Second Contact: Name
Relationship
Phone Number
-
Area Code
Phone Number
Please list allergies, medical concerns, physical restrictions, behavioral issues, current medications, etc. that we need to be aware of while your child is at camp with us OR type "None":
*
I have provided Our Pal’s Place, Camp O.P.P. with all needed information to keep my child safe while at camp. Type name below which represents your signature
*
Submit
Should be Empty: