Camp Adventure Summer Camp
Camper Location
*
Please Select
Imagine Nation Greek Oaks
Imagine Nation Arborgate
Imagine Nation Walnut Creek
Imagine Nation Waxahachie
Walnut Creek Academy
Camper's Information
# of Campers Enrolling
*
Camper's Name
*
First Name
Last Name
Age
*
Gender
*
Please Select
Male
Female
Date of Birth
*
-
Month
-
Day
Year
Date
School Name
*
School/Grade Level
*
Camper's Photo (Optional)
*
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Camper's Name
First Name
Last Name
Age
Gender
Please Select
Male
Female
Date of Birth
-
Month
-
Day
Year
Date
School Name
School/Grade Level
Camper's Photo (Optional)
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Camper's Name
First Name
Last Name
Age
Gender
Please Select
Male
Female
Date of Birth
-
Month
-
Day
Year
Date
School Name
School/Grade Level
Camper's Photo (Optional)
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Parent/Guardian Information
The parents/guardian listed below will be the authorized person to pick-up the child after the camp.
The parents/guardian listed below will also be the primary emergency contact person.
Name
*
First Name
Last Name
Relation
*
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Picture upload
*
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Name
First Name
Last Name
Relation
Phone Number
-
Area Code
Phone Number
Picture upload
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Medical Information
Does the child have any allergies? If yes, please list them below:
Does the child have any previous injuries? If yes, please explain them below:
Does the child have any current medical conditions? If yes, please list them below:
Does the child takes any medication? If yes, please list them below and explain its purpose:
Payment Details
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Registration Per Family
$
50.00
Total
$
0.00
Authorization
I, the parent/guardian of this camper gives authority to the staff of this camp to apply judgment in regards to medical assistance in the event of an accident, injury, or illness if the emergency contact person cannot be reached. I authorized first aid, medical/surgical diagnosis, and treatment which may deem necessary.
I released the organizers, coaches, staff, or managers of this camp for any responsibility in case of accident, illness, or injury during my child's enrollment.
I confirm that all information given in this form is true, complete, and accurate.
Parent/Guardian Signature
*
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First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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