BETTER CAMP 23 REGISTRATION
JUNE 21-JUNE 24 | This registration form is required for your student to attend camp. Upon submission, you'll receive a confirmation email with a link to download a required Better Camp 23 Release Form and a link for online registration payments.
Camper's Information
Please let us know about your student!
Camper's Name
*
First Name
Middle Name
Last Name
Camper's Date of Birth
*
-
Month
-
Day
Year
Date
Camper's Cell (If applicable)
-
Area Code
Phone Number
Gender
*
Male
Female
Grade Fall 2023
*
Please Select
6th
7th
8th
9th
10th
11th
12th
T-Shirt Size
*
Please Select
S
M
L
XL
XXL
Does your child have any allergies, chronic illness, or medical conditions?
*
Yes
No
If yes, please describe.
Is your child prescribed an inhaler?
*
Yes
No
If yes, please explain any instructions.
Does your child have any medication he/she is required to take while at camp?
*
Yes
No
I hereby authorize any Garden Youth Leader to administer the following non-prescription items as needed to my child. (Please select the authorized medications. Medications not selected will not be administered.)
*
Acetaminophen (Tylenol)
Ibuprofen (Advil)
Antacid
Topical and/or first aid items may be utilized by adult leaders unless there is a specific objection by the parent/guardian. Please list any topical or first aid items that are NOT to be used.
*
Does your child have any food allergies or dietary restrictions?*
*
Parents/Guardian Information
Parent's Name
*
First Name
Last Name
Cell Phone
*
E-mail
*
Alternate Parent's Name
First Name
Last Name
Cell Phone
E-mail
example@example.com
Emergency Information
If there's an emergency and we are not able to reach a parent listed above, please designate an alternate Emergency Contact for your student.
Emergency Contact (Other than parent above)
*
First Name
Last Name
Relationship
*
Please Select
Mother
Father
Grandparent
Aunt
Uncle
Sibling
Other
Emergency Contact Number
*
-
Area Code
Phone Number
Parent Signature
*
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