Summer Camp Registration Form

Summer Camp Registration WAITLIST

July 1st-15th, 2024
Camper Name
Last Name*
First Name*
Middle Name*
Gender*

MaleFemale
Camper's Information
Address*
City*
State*
Zip*
Home Phone*

Area CodePhone Number
Emergency Contact Name(if parent or guardian is not avaliable)*
Emergency Number*

Area CodePhone Number
Birth Date*

MonthDayYear
Grade entering in the fall*
Parent or Legal Guardian Information
Parent/Legal Guardian*
Relation*
Work Phone*

Area CodePhone Number
Cell Phone

Area CodePhone Number
Parent /Legal Guardian 2
Relation 2
Work Phone 2

Area CodePhone Number
Cell Phone 2

Area CodePhone Number
Email Confirmation
Parents Email (camper confirmation will be sent by email, if left blank it will be mailed)
Other Information
How did you hear about RGE Cares Summer Camp?
First Time Camper?*

YesNo
Health Information

A health officer is on site at all times.
It is our policy to contact the parent or guardian as soon as possible in the event of a serious accident or injury.
Any activity the camper should be restricted from?*
Any physical, mental or other condition that would require special attention or medication while at camp?*
List any allergies (ex: bees,peanuts, dairy)*
Any dietary needs that we should know about?*
Camper Release
Camper Release (List anyone, including parents, to whom your camper can be released)*
- Be certain to enter your email address correctly on the registration form to receive confirmation via email with in 2 weeks
By hitting submit and putting your initials, you agree that you are the parent or legal guardian of the above named camper, and are over the age of 18. In case of medical emergency or general medical care, I give consent for medical teatment for the aboved named camper by authorized personnel. The camp carries secondary insurance. I understand that the above named camper will only be released to the names listed above, an update may be done at registration. I certify that my child has my permission to attend camp and participate in all activites. I authorize The Springs to use my camper's picture, testimony, and video in any promotional material(web,print,or media) My child may recieve any e-mails from the camp.
Electronic signature, please initial*
Should be Empty:

Summer Camp Registration WAITLIST

Camper Name

Camper's Information

Parent or Legal Guardian Information

Email Confirmation

Other Information

Health Information

Camper Release