Summer Camp Enrollment Form

Summer Camp Registration
CAMPER INFORMATION:
Individual Name *

First Name Last Name
Birth Date *

Month Day Year
Age *
Name of School/ Organization *
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
E-mail *
MEDICAL INFORMATION
Physician Name

First Name Last Name
Phone Number

Area Code Phone Number
Medical Concerns
* Please list all medications to be administered.
Choose Your Camp

Overnight Camp (ages 6-17) Day Camp (ages 6-17) Adult Basketball Camp
Choose Your Camp Week(s)
Example: Week 1,2,3
Should be Empty:

Summer Camp Registration