Summer Camp Enrollment Form

T2C3 Gone Fishin' Day Camp

Saturday, June 3, 2023 9am to 2pm
CHILD INFORMATION:

Please Bring a towel, appropriate swim suit or a change of clothes.
Birth Date*

MonthDayYear
Grade4th*
Child Name*
Name of School
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail
Emergency Contact *

First NameLast Name
Relationship
Phone Number*

Area CodePhone Number
MEDICAL INFORMATION
Physician Name

First NameLast Name
Phone Number

Area CodePhone Number
Allergies/Medical Issues (if none, n/a)*
Health Insurance Co.
Group Number

T2C3 Gone Fishin' Day Camp