Camp Registration Form Sat October 26, 2024 Jacksonville, FL
These forms are required for your children to attend camp.
Camper's Information
Camper Name
*
Nickname
Date of Birth
*
-
Month
-
Day
Year
Date Picker Icon
Age
Please Select
5
6
7
8
9
10
11
12
13
14
Current Grade in 2024-2025
*
Please Select
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
T-Shirt Size
*
Please Select
YS
YM
YL
AS
AM
AL
Baseball Pants Size
YS
YM
YL
AS
AM
AL
Shoe Size (Based on Sizes/Quantity available may be awarded as prizes)
How did you find us?
Previously Attended
Instagram/Social Media
TV/Newspaper
Camp Flyer
Referred by Family/Friend
Camper Baseball Experience
*
No Experience- First Time
Beginner- Non organized team
Some Prior Experience- Played on a Youth Team
Advanced- Played on an Competitive Team
Other
Please provide any additional information that you think is important for our staff to know or may affect the camper's ability to fully participate in the camp program.
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Parents' Information
Parent/Guardian
Parent/Guardian 1
*
First Name
Last Name
Relationship to Child
*
E-mail
*
Cell Phone
*
Format: (000) 000-0000.
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Emergency Contacts/Authorized Pickup
List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be within one hour of the center/home, able to take responsibility for the child in case the parent/guardian cannot be contacted and should be at least 18 years of age. The first emergency contact must live no more than 1 hour away and be over the age of 18.
Emergency Contact #1
Full Name
*
First Name
Last Name
Primary Phone Number
*
Format: (000) 000-0000.
Relationship to Child
*
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Medical / Health Information
Is the child up-to-date on all immunizations?
*
Yes
No
Does your child have any food, medication or environmental allergies?
*
Yes
No
Allergies? Check all that apply
*
Food
Medication
Environmental
Please list and explain any allergies
*
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Does your child’s allergy/allergies require child care staff to monitor child for symptoms, take action if a reaction occurs, or give emergency medication to your child?
*
Yes
No
Does your child have a special health or medical condition?
*
Yes
No
Please explain
*
0/150
Does the special health or medical condition require child care staff to perform a procedure, or perform child specific care such as: to monitor your child for symptoms or administer medication during child care hours?
*
Yes
No
Is your child currently using any medication?
*
Yes
No
Please explain
*
0/150
Does your child have any dietary restrictions, including those for medical, religious or cultural reasons?
*
Yes
No
Please explain
*
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SUBMIT
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