Riverside Adventure Camp Application
June 11th-14th 10am-4:00pm
Camper Name
First Name
Middle Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Gender
Male
Female
Email
example@example.com
Phone Number
Mobile Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Camper T-shirt size (shirts are in adult sizes)
XXS
XS
S
M
L
XL
Medical Information
Lunch is provided daily so please list any dietary restrictions under allergies!
Does the camper have allergies including asthma? (Lunch is provided daily, so please include dietary restrictions)
Please explain on the field provided
Is the camper currently taking medication?
Please provide the details, the name of the medication and period of intake
Contact Information in Case of Emergency
Name
First Name
Last Name
Contact Number
-
Area Code
Phone Number
Relation to camper
Name
First Name
Last Name
Contact Number
-
Area Code
Phone Number
Relation to camper
Payment
My Products
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Summer Camp
$
120.00
Quantity
1
2
3
4
5
6
7
8
9
10
Total
$
0.00
Credit Card
Signature of applicant or guardian representative
Submit
Should be Empty: