Spring Break Camp Registration

Spring Break Camp Registration
Which week will your camper be attending?
Camper Information
Camper's Name

First NameLast Name
Age
Age at time of camp
Birth Date

MonthDayYear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Information
Name

First NameLast Name
Home Number

Area CodePhone Number
Cell Number

Area CodePhone Number
E-mail (@arizona emails are not accepted)
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number

Area CodePhone Number
Alt. Phone Number

Area CodePhone Number
Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.
If none, please just say no.
Is the camper prescribed an inhaler or insulin? If yes, please explain any instructions.
Does you child have any behaviors TRAK staff should be aware of?
Insurance Provider
Insurance Policy Number
Waiver of Liability and Media Release
Waiver Liability
Waiver Liabiltiy Signature
Media Release
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Are you a TRAK Member?
TRAK Camp
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trak MEMBER payment$386.51

trak NON-MEMBER payment$412.26

trak MILITARY MEMBER payment$347.50

trak MILITARY NON-MEMBER payment$371.06

Total $0.00
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