Summer Camp Registration

Summer Camp Registration

July 28 - Aug 1, 2025
2025 MEMBERSHIP RENEWAL REQUIRED

To register for summer camp, all girls must have a current Girls, Inc. annual membership. If needed, you can complete membership registration here. All services and any outstanding balances must be paid in full before the activity start date.
Student Information
Student Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Age*
Birthdate*

MonthDayYear
Date
Grade Entering *
School Attending
T-Shirt Size*
Primary Guardian Information
Primary Guardian's Name*

First NameLast Name
Primary Guardian's Relationship*
Primary Guardian's Phone Number*
Please enter a valid phone number.
Primary Guardian's Email*
example@example.com
Primary Guardian's Employer
Secondary Guardian Information
Secondary Guardian's Name

First NameLast Name
Secondary Guardian's Relationship
Secondary Guardian's Phone Number
Please enter a valid phone number.
Secondary Guardian's Email
example@example.com
Secondary Guardian's Employer
Additional Emergency Contact

Other than guardian(s) listed above
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.
Emergency Contact Relationship
Medical Information
Does child have insurance coverage?*
Name of Insured
Insurance Carrier
Policy Number
Physician's Name
Physician's Phone Number
Please enter a valid phone number.
Preferred Hospital
Chronic Illness or Recent Operations
Allergies
List any known allergies to foods, drugs, plants, animals, etc.
Does the child experience any of the following? If so, please explain.
Additional Health Information or History
Has she started to menstruate?*
If no, has she been told about it?
Any restrictions which would limit participation in camp activities?
Medical Authorization

Prescription medication MUST come in the original bottle & be labeled with camper's name.
Administration of All Medication*
Emergency Authorization*
Non-Prescription Medication Authorization*
Allowed Medications

Tylenol (Children)Tylenol (Junior)Tylenol (Adult)Cough Syrup (Children)Cough Syrup (Junior)Cough Syrup (Adult)Motrin (Children)Motrin (Junior)Motrin (Adult)Benadryl (Children)Benadryl (Junior)Benadryl (Adult)Ibuprofen (Children)Ibuprofen (Junior)Ibuprofen (Adult)Allergy Med (Children)Allergy Med (Junior)Allergy Med (Adult)Visine Eye DropsPepto BismolCalamine LotionMidolSwimmer's Ear DropsBasic First Aid (antibiotic cream, aloe vera gel, athlete's foot cream, bug repellent, peroxide, alcohol, hydrocortisone cream, antiseptic wash, baby powder, sting/bite relief, liquid bandage, bactine spray).
Additional Medication Comments
Camp Rules

To be signed by both the camper and the guardian
- All campers must obey counselors. This is important for the safety and enjoyment of all the campers.
- Parents should not attempt to phone their children at camp except in an emergency. If necessary, the camp director will phone parents.
- All medication must be turned in before departure.
- Girls are not allowed to bring food or candy to camp.
- Girls should not bring money to camp.
Agreement to Camp Rules*
Camper Signature*

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Camper Date Signed*

MonthDayYear
Date
Parent/Guardian Signature*

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Parent/Guardian Date Signed*

MonthDayYear
Date
Camp Fees

Camp fees are non-refundable and must be paid at the time of registration. Please inquire in our office if financial assistance or payment plans are necessary. Assistance provided in part by CDBG funds.
Pay Now*
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Girls, Inc. Summer Camp Registration
$100.00

Total

$0.00
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Summer Camp Registration

Student Information

Primary Guardian Information

Secondary Guardian Information

Additional Emergency Contact

Medical Information

Medical Authorization

Camp Rules

Camp Fees