Kids Camp Registration

Shoutout Kids Camp

June 13 - 17
Child's Name

First Name Last Name
Child's Age
Boy Girl
Child's date of birth
School grade completed
Parent / Guardian Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Emergency contact number #1
Emergency contact number #2
Child's Tshirt size
Insurance Company & Policy Number
Please list any allergies or recreational limits:
I give permission for my child, listed above, to attend this camp. In case of accident or emergency, I grant the camp superintendent permission to authorize medical attention by a physician or hospital as necessary. You will be notified immediately.
Signature

Clear
Date
Should be Empty:

Shoutout Kids Camp