Summer Camp Detailed Registration Form

Camper Information
Camper’s Name

First NameLast Name
Birth Date

MonthDayYear
Gender

MaleFemale
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Home Number
Cell Number
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Alt. Phone Number
Is the camper prescribed an inhaler? If yes, please explain any instructions.
Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.
Camp Rules:

Please do not bring cell phones or any electronic devices to camp
PACK FOR CAMP!
- Beach towel
- water shoes
- hiking shoes
- boots with heal
- t-shirt to tie-dye
- backpack
- sunscreen
- bug spray
- sleeping bag
- pillow
- Bible
- swimsuit
Type a question
Should be Empty: