New Generation Backyard Pod Camp Registration Form
Fill out the form carefully
Parent Information
Parent Information
Parent's Name
*
First Name
Last Name
Parent's E-mail
*
Home Number
-
Area Code
Phone Number
Cell Number
*
-
Area Code
Phone Number
Network
*
Please Select
Digicel
Lime
Camper Information
Camper Information
Camper #1:
*
First Name
Middle Name
Last Name
Date Of Birth
*
/
Month
/
Day
Year
Date Picker Icon
Today
-
Month
-
Day
Year
Date Picker Icon
Age
Gender
*
Please Select
Male
Female
N/A
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
School
Church
Camper #2:
First Name
Middle Name
Last Name
Date Of Birth
/
Month
/
Day
Year
Date Picker Icon
Today
-
Month
-
Day
Year
Date Picker Icon
Age
Gender
Male
Female
N/A
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
School
Church
New Generation would like your permission for your child to participate in the following:
Camp Information
Camp Information
Year
*
Please Select
2022
2021
2020
2019
Name of Parent Liaison:
*
Cell number of Parent Liaison:
*
Name of your Pod:
*
Proposed Pod Camp Location:
*
Please select the relevant options below:
Pod size
*
5 - 7 campers
8 - 10 campers
11 - 13 campers
14 and more
Camp time slot:
*
9 am - 2 pm
12 pm - 5 pm
Length of camp:
*
1 week
2 weeks
Health Information
Health Information
Health History
Details
Medication to be given to camper
Any other important Information
Covid-19 Intake
If my child/children have any signs or symptoms of a respiratory infection such as fever, cough, shortness of breath, body aches or sore throat, I will not take them to camp
*
I Agree
Have you or any of your family members had any signs or symptoms of a respiratory infection in the past 14 days?
*
yes
no
Have you or your child/children traveled to a Covid-19 infected area recently?
*
yes
no
Have you come into close contact (within 6 feet) with someone with a laboratory-confirmed Covid-19 diagnosis in the past 14 days?
*
yes
no
Emergency Contact
Emergency Contact
Emergency Contact #1
*
First Name
Last Name
Home Number
-
Area Code
Phone Number
Work Number
-
Area Code
Phone Number
Cell Number
*
-
Area Code
Phone Number
Emergency Contact # 2
First Name
Last Name
Home Number
-
Area Code
Phone Number
Work Number
-
Area Code
Phone Number
Cell Number
-
Area Code
Phone Number
Submit Form
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