Fort Myers Summer Camp Registration

Medical Information
Does this camper have any medical conditions, health problems, allergies, dietary needs, learning differences, or other concerns we should be aware of?*
Is this camper currently using any medication we should be aware of?*
Emergency Contacts and Authorized Pick Up

The individuals in this section will be contacted in the event of an emergency, IF the parent listed in section 1 are unable to be reached. The individuals listed here and the parent in section 1 are authorized to pick up this student from Camp HSR! and to receive information regarding this student.
Second Parent or Emergency Contact*

First NameLast Name
Second Parent or Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Third Emergency Contact *

First NameLast Name
Third Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
By registering for Summer Camp, permission is granted to use any photographs or videos of your child in connection with publicity for Fort Myers Summer Camp Photos and videos may be posted on Facebook, Instagram, our website, and other social media. Photos may also be printed for distribution. We will never attach a child's name or personal information to any photo or video without explicit written permission.*

Agree
Agree

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Family Information