Summer Camp Enrollment
Summer Camp Enrollment Form (one form per child)
Camper Information
Camper Information
*
First Name
Last Name
Gender
Camper Date of Birth
-
Month
-
Day
Year
Parent/Guardian Information
Parent/Guardian Name
*
First Name
Last Name
Relationship to Camper
Email
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Medical Information
Allergies
Medical Conditions
Medications
Dietary Restrictions
Family Doctor's Name
Family Doctor's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Permissions and Agreements
Photo/Video Release:
I give permission for my child’s photos/videos to be used for camp promotionalmaterials.
I do not give permission for my child’s photos/videos to be used.
Medical Release:
I authorize the camp to provide necessary medical treatment to my child in caseof emergency.
I do not authorize the camp to provide medical treatment.
Parent/Guardian of Camper Signature
*
Submit
Submit
Should be Empty: