Summer Camp at Lee Brothers 2022

Lee Brothers Camp for Kids

Raleigh, NC (919) 846-1234
Information about your child:
Child's Name *

First Name Last Name
Birth Date *

Month Day Year
Age *
Gender *

Male Female
Any Medical Conditions, Allergies, Dietary Restrictions, or Special Needs we should be aware of?
Parent / Guardian information:
Parent/Guardian 1 *

First Name Last Name
Relationship to Child *
E-mail *
Primary Phone *

Area Code Phone Number
Secondary Phone

Area Code Phone Number
Parent/Guardian 2

First Name Last Name
Relationship to Child
E-mail
Primary Phone

Area Code Phone Number
Secondary Phone

Area Code Phone Number
Emergency Contact other than parent *

First Name Last Name
Relationship to Child *
Emergency Contact Phone *

Area Code Phone Number
If you would like to authorize any other adults not listed on this form to pick your child(ren) up from camp, please notify us when you come to camp.

2 Member contact info start
Lee Brothers Camp for Kids

Raleigh, NC (919) 846-1234
Information about your child:
Child's Name *

First Name Last Name
Birth Date *

Month Day Year
Age *
Gender *

Male Female
Child #2 Name *

First Name Last Name
Birth Date *

Month Day Year
Age *
Gender *

Male Female
Any Medical Conditions, Allergies, Dietary Restrictions, or Special Needs we should be aware of?
Parent / Guardian information:
Parent/Guardian 1 *

First Name Last Name
Relationship to Child *
E-mail *
Primary Phone *

Area Code Phone Number
Secondary Phone

Area Code Phone Number
Parent/Guardian 2

First Name Last Name
Relationship to Child
E-mail
Primary Phone

Area Code Phone Number
Secondary Phone

Area Code Phone Number
Emergency Contact other than parent *

First Name Last Name
Relationship to Child *
Emergency Contact Phone *

Area Code Phone Number
If you would like to authorize any other adults not listed on this form to pick your child(ren) up from camp, please notify us when you come to camp.

3 Member contact info start
Lee Brothers Camp for Kids

Raleigh, NC (919) 846-1234
Information about your child:
Child's Name *

First Name Last Name
Birth Date *

Month Day Year
Age *
Gender *

Male Female
Child #2 Name *

First Name Last Name
Birth Date *

Month Day Year
Age *
Gender *

Male Female
Child #3 Name *

First Name Last Name
Birth Date *

Month Day Year
Age *
Gender *

Male Female
Any Medical Conditions, Allergies, Dietary Restrictions, or Special Needs we should be aware of?
Parent / Guardian information:
Parent/Guardian 1 *

First Name Last Name
Relationship to Child *
E-mail *
Primary Phone *

Area Code Phone Number
Secondary Phone

Area Code Phone Number
Parent/Guardian 2

First Name Last Name
Relationship to Child
E-mail
Primary Phone

Area Code Phone Number
Secondary Phone

Area Code Phone Number
Emergency Contact other than parent *

First Name Last Name
Relationship to Child *
Emergency Contact Phone *

Area Code Phone Number
If you would like to authorize any other adults not listed on this form to pick your child(ren) up from camp, please notify us when you come to camp.

Lee Brothers Camp for Kids

Raleigh, NC (919) 846-1234
Information about your child:
Child's Name *

First Name Last Name
Birth Date *

Month Day Year
Age *
Gender *

Male Female
Any Medical Conditions, Allergies, Dietary Restrictions, or Special Needs we should be aware of?
Parent / Guardian information:
Parent/Guardian 1 *

First Name Last Name
Relationship to Child *
E-mail *
Primary Phone *

Area Code Phone Number
Secondary Phone

Area Code Phone Number
Parent/Guardian 2

First Name Last Name
Relationship to Child
E-mail
Primary Phone

Area Code Phone Number
Secondary Phone

Area Code Phone Number
Emergency Contact other than parent *

First Name Last Name
Relationship to Child *
Emergency Contact Phone *

Area Code Phone Number
If you would like to authorize any other adults not listed on this form to pick your child(ren) up from camp, please notify us when you come to camp.

2 Guests contact info start
Lee Brothers Camp for Kids

Raleigh, NC (919) 846-1234
Information about your child:
Child's Name *

First Name Last Name
Birth Date *

Month Day Year
Age *
Gender *

Male Female
Child #2 Name *

First Name Last Name
Birth Date *

Month Day Year
Age *
Gender *

Male Female
Any Medical Conditions, Allergies, Dietary Restrictions, or Special Needs we should be aware of?
Parent / Guardian information:
Parent/Guardian 1 *

First Name Last Name
Relationship to Child *
E-mail *
Primary Phone *

Area Code Phone Number
Secondary Phone

Area Code Phone Number
Parent/Guardian 2

First Name Last Name
Relationship to Child
E-mail
Primary Phone

Area Code Phone Number
Secondary Phone

Area Code Phone Number
Emergency Contact other than parent *

First Name Last Name
Relationship to Child *
Emergency Contact Phone *

Area Code Phone Number
If you would like to authorize any other adults not listed on this form to pick your child(ren) up from camp, please notify us when you come to camp.

3 Guests contact info start
Lee Brothers Camp for Kids

Raleigh, NC (919) 846-1234
Information about your child:
Child's Name *

First Name Last Name
Birth Date *

Month Day Year
Age *
Gender *

Male Female
Child #2 Name *

First Name Last Name
Birth Date *

Month Day Year
Age *
Gender *

Male Female
Child #3 Name *

First Name Last Name
Birth Date *

Month Day Year
Age *
Gender *

Male Female
Any Medical Conditions, Allergies, Dietary Restrictions, or Special Needs we should be aware of?
Parent / Guardian information:
Parent/Guardian 1 *

First Name Last Name
Relationship to Child *
E-mail *
Primary Phone *

Area Code Phone Number
Secondary Phone

Area Code Phone Number
Parent/Guardian 2

First Name Last Name
Relationship to Child
E-mail
Primary Phone

Area Code Phone Number
Secondary Phone

Area Code Phone Number
Emergency Contact other than parent *

First Name Last Name
Relationship to Child *
Emergency Contact Phone *

Area Code Phone Number
If you would like to authorize any other adults not listed on this form to pick your child(ren) up from camp, please notify us when you come to camp.

You will receive email confirmation of your registration once you complete your payment.
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Lee Brothers Summer Camp