October 2021 Camp Registration Form

Xmas 2021 Camp Registration Form

To book for a place in the the camp, you must complete the form below accurately.
Childs Name: *

First Name Last Name
Desired Name :
Birth Date: *

Month Day Year
Home Phone Number: *
Mobile Number:
Parent's Email Address: *
example@example.com
Primary Address: *

Street Address

Street Address Line 2

Parish State / Province

Zip
Please provide any medical or dietary restrictions you have:
How did you hear about Camp?: *
Family Information
Parent/Guardian's Name: *

First Name Last Name
Contact Phone Number: *
E-mail Address: *
example@example.com
Emergency Contact Information
Emergency Contact Name: *

First Name Last Name
Emergency Contact Phone Number: *
Relationship to Student: *
Your child will be attending

Week1 December 20 -24
Should be Empty:

Xmas 2021 Camp Registration Form