Parent name: First Name* Last Name* Parent email:Email*Parent Phone: Area Code* Phone Number* Emergency Contact Name: First Name* Last Name* Emergency Contact: Area Code* Phone Number* Child 1 name:blanks* grade: blank* t-shirt sizeblankChild 2 name:blanks grade: blank t-shirt sizeblankChild 3 name:blanks grade: blank t-shirt sizeblankChild 4 name:blanks grade: blank t-shirt sizeblank
Individual(s) allowed for pick up are:Name: blanks* and phone: blank*Name: blanks* and phone: blank*
Insurance Carrier: blanks* ID Number: blank*Group Policy Number:blank*Phone Number on the back of the insurance card: blank*Camper(s) Primary Care Physician: blank*Primary Physician Phone:blank*