Summer Camp Registration
*If registering multiple children, please submit separate applications for each
Select Date for Camp Registration (Both can be selected)
*
Information
Child's Name
*
First Name
Last Name
Child Age
*
Please Select
7
8
9
10
11
12
Select age child will be as of September 30, 2024
Gender
Male
Female
Contact Information
Parent/Legal Guardian Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Emergency Contact(s)
Contact 1
*
First Name
Last Name
Contact 1 Phone Number
*
Please enter a valid phone number.
What is Contact 1's relationship to the child? (ie; grandparent, legal guardian, etc.)
*
Mother
Father
Grandparent
Legal Guardian
Other
Contact 2
First Name
Last Name
Contact 2 Phone Number
Please enter a valid phone number.
What is Contact 2's relationship to the child? (ie; grandparent, legal guardian, etc.)
Mother
Father
Grandparent
Legal Guardian
Other
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Medical Information
Does your child have any allergies?
*
Yes
No
If yes, please specify what allergies.
Can include food allergies, animal allergies, etc.
Does your child have any dietary restrictions?
*
Yes
No
If yes, please specify
Can include; Halal, vegetarianism, intolerances, etc.
Does your child have any disabilities, mental health concerns, etc. that we should know about? (This includes things like anxiety, ADHD, etc.)
*
Yes
No
If yes, please specify so we can offer proper support and care for your child
Is there anything else we should know about your child?
If no, you can leave box blank or type no
Signature, verifying that all information above is correct and all necessary information has been disclosed.
*
Submit
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