Camp Kai Registration Form

Camp Kai at Wai Kai

Jr. Waterman Camp
Camp Kai Registration Form
Child's Name

First NameLast Name
Birth Date

MonthDayYear
T-Shirt Size
Mini Grom 8-10 Years OldGrom 11-13 Years OldCounselor In Training 14-15 Years Old
Current School
Current Grade Level
MaleFemaleOther
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
June 5th-9thJune 12th- 16thJune 19th-23rdJune 26th- 30th
July 10th-14thJuly 17th- 21stJuly 24th- 28thJuly 31st- Aug 4th
Parent/Guardian Information #1
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Number
Format: (000) 000-0000.
Cell Number
Format: (000) 000-0000.
E-mail
example@example.com
Parent/Guardian Information #2
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Number
Cell Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Child Resides with
Any Special Instructions such as custody agreements, please attach to application and discuss with Camp Director..
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
Person's allowed to pick up the child.

Must have valid ID at pickup for child to be released.
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Does the child have any food allergies or dietary concerns? If yes, please describe.
Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Does your know how to swim? Please describe their swimming experience.
Please describe any experience on watercraft? Ex: surfing, SUP, bodyboard etc.
YesNo
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
MonthDayYear
Date
Signature

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Camp Kai at Wai Kai

Camp Kai Registration Form

Parent/Guardian Information #2

Person's allowed to pick up the child.