Camp 2023 Registration

Camp 2023 Registration

Please fill out and submit this form for each daughter who will be attending camp.
Cost: $150 ($200 family max $25 discount if applying before April 1.

Payment can be made online or a check can be mailed to:

Wiggins House 34 Wiggins St, Princeton, NJ 08540 (attn: Camp Laurelwood)
Name of camper*
Registering as a*
Home Address (street, city, state, zip code)*
Mom's first and last name*
Mom's Phone Number*
Mom's email*
example@example.com
School*
Age as of July 1, 2023*
Date of birth*

MonthDayYear
Date
Grade level September 2023*
If an emergency arises while my daughter is at Camp Laurelwood I direct the Camp Laurelwood staff to try to contact me. If I cannot be reached in the case of an emergency, Rose Marie McCabe or her designee is directed to seek emergency care for my daughter at the nearest hospital facility.
Signature*

Clear
Date*

MonthDayYear
Date
Emergency Contact
Second Parent or Emergency Contact*
Relationship of Emergency Contact*
Emergency Contact Phone*
Health Information
Relevant health information
Chronic or recurring illness or medical condition
Doctor's Name*
Doctor's Phone*
Currently under the care of a physician for the following condition(s)
Any allergies (food, drugs, plants, insects, etc.)
Suggestions or additional health related information for program staff
Insurance carrier*
ID #*
Photo Release

Please contact Katie Schneider (schneider.katie.r@gmail.com / 215-359-7709) if you do not want your daughter's photos used. These pictures would be potentially used on the Camp Laurelwood website, the Wiggins House newsletter, and future camp flyers/brochures.
I give my permission to the Laurelwood staff to take photographs or videos of my daughter to be used in future Laurelwood promotions.
Parent signature

Clear
Should be Empty:

Camp 2023 Registration

Emergency Contact

Health Information

Photo Release