Rag & Bone Shakespeare Camp Registration

Shakespeare Summer Camp Registration
Camper's Name*

First NameLast Name
Pronoun
Preferred name (if different from above)
Camper's birthdate*

MonthDayYear
Date of birth
Primary Contact
Relationship to camper*

MotherFatherLegal GuardianOther
Name*

First NameLast Name
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Daytime phone number*

Area CodePhone Number
Do you have other phone numbers?

YesNo
Work number

Area CodePhone Number
Other phone number

Area CodePhone Number
Preferred E-mail*

Emergency Secondary Contact Information
Name*

First NameLast Name
Daytime phone number*

Area CodePhone Number
Other phone numbers?

YesNo
Work number

Area CodePhone Number
Other phone number

Area CodePhone Number
Relationship to camper*

MotherFatherLegal GuardianOther
Is this person permitted to pick up child from camp?*

YesNo
Others who may pick up your child from camp:

Personal information
Child lives with*

Both parentsMotherFatherLegal GuardianOther
Does the child have any allergies; sensitivities; medical, physical or emotional needs we should be made aware of?*

YesNo
If yes, please describe them, and tell us about any medical instructions or accommodations required onsite.