iCamp Camper Registration Form 2025

2025 iCAMP Camper Registration Form

These forms are required for your children/participant to attend camp.
Camper's Information
Camper Name*
Gender/sex*
Date of Birth*

MonthDayYear
Age
NOTE - Children/Participant will need to be accompanied by a parent or caregiver if ANY of the following are required.
- Need help using the bathroom or wear diapers or depends and need assistance changing
- Need assistance changing clothes when applicable (usually on the water activities and pool)
- Use a mobility device which requires assistance on rough and off-road enviroments
- Use of precription medication(s) that must be taken during the time period the camper is at camp
Will a parent or caregiver be accompanying camper?
What days will the camper attend?
T-Shirt Size*
Camper Swimming Ability*

Non-SwimmerBeginner Swimmer (can swim on front 20ft without flotation)Advanced Swimmer (can pass swim test)
Please provide any additional information that you think is important or may affect the camper's ability to fully participate in the camp program.

Parents' Information

Parent/Guardian 1
Parent/Guardian 1*

First NameLast Name
Relationship to Camper*
E-mail*
example@example.com
Cell Phone*
Home Phone*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Work/School Name*
Or enter N/A if not applicable
Parent's Work/School Phone
Where would you like to be reached while your camper is at camp?*

Cell PhoneWork PhoneHome Phone
Parent/Guardian 2
Parent/Guardian 2*

First NameLast Name
Relationship to Camper*
E-mail*
example@example.com
Cell Phone*
Home Phone*
Home Address Same as Parent/Guardian 1?

Yes
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Work/School Name*
Or enter N/A if not applicable
Parent's Work/School Phone*
Where would parent/guardian 2 like to be reached while your camper is at camp?

Cell PhoneWork PhoneHome Phone

Emergency Contacts/Authorized Pickup

Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be within one hour of the center/home, able to take responsibility for the camper in case the parent/guardian cannot be contacted and should be at least 18 years of age. The first emergency contact must live no more than 1 hour away and be over the age of 18.
EMERGENCY INFORMATION

Emergency Contact #1
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Secondary Phone Number*
Relationship to Camper*
EMERGENCY INFORMATION

Emergency Contact #2
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Secondary Phone Number*
Relationship to Camper*

Payment and Statement of Understanding
The iCAMP (Camp 2:42 Inc) has permission to secure emergency transportation for my child in the event of an illness or injury which requires emergency treatment. The emergency transportation service will determine the facility to which my child will be transported.*
Type first and last name above to consent
This form, after being completed and signed by the parent/guardian, must be reviewed for completeness and signed by the administrator/designee prior to the child receiving care. After the child is attending the program the administrator shall have the parent/guardian review and initial the form when any changes/updates are made and at least annually. The parent/ guardian and the administrator or designee shall initial and date the form in the section below to indicate when the form was last reviewed.*
Type first and last name above to consent
Acknowledgement of Policies and Procedures I have reviewed and received a copy of the center's policies and procedures/handbook.*

YesNo
Sign Document*
Date Signed*

MonthDayYear
Camp Director Name and Contact Info
My Products
prevnext( X )
Camp Fee
$125.00

Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

2025 iCAMP Camper Registration Form