Southern Sitters Westhaven Camp 2024 Registration

Parents' Information

Parent/Guardian 1
Parent/Guardian 1*

First NameLast Name
Relationship to Children*
E-mail*
Cell Phone*
Home Phone
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Work/School Phone
Where would you like to be reached while your child is at camp?*

Cell PhoneWork PhoneHome Phone
Contact

Parent/Guardian 2
Parent/Guardian 2

First NameLast Name
Relationship to Children
E-mail
Cell Phone
Home Phone
Home Address Same as Parent/Guardian 1?

Yes
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Where would parent/guardian 2 like to be reached while your child is at camp?

Cell PhoneWork PhoneHome Phone

Emergency Contacts/Authorized Pickup

Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. Person listed must be within one hour of the Westhaven Resident's Club able to take responsibility for the child in case the parent/guardian cannot be contacted and should be at least 18 years of age.
Full Name*

First NameLast Name
Phone Number*
Relationship to Child*

Payment and Statement of Understanding
IMPORTANT PAYMENT INFORMATION: Southern Sitters will email a camp deposit invoice within 48 hours of form submission of $100 per camper per week. This invoice must be completed within 48 hours of recipience to hold each child's spot. This is not an additional payment; it will be deducted from your total tuition.*

I understand the above information.Other
Southern Sitters has permission to secure emergency transportation for my child in the event of an illness or injury which requires emergency treatment. The emergency transportation service will determine the facility to which my child will be transported.*
Type first and last name above to consent.
Sign Document*
Date Signed*

MonthDayYear