Camp Registration Form
Please complete the form below accurately and completely
Camper Name
*
First Name
Last Name
Birth Date
*
-
Month
-
Day
Year
Date Picker Icon
Desired Name Tag
Preferred Pronouns and Gender Identity
*
Please Select
She/Her
He/Him
They/Them
Cabins are segregated by gender identity, if a camper does not identify with either Girls or Boys, please choose where they would be most comfortable for sleeping arrangements.
Cabin Assignments if pronouns are they/them
Girls Cabins
Boys Cabins
Primary Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Select Camp Shirt Size
X Small
Small
Medium
Large
X Large
Please provide any medical concerns, allergies, or dietary restrictions you have. Type N/A if none applicable.
*
How did you hear about Camp?
Please Select
Email
Print Ads
Radio
Referral
Event
Social Media
Camp Activity Interest
*
Swimming
Canoe/Kayak
Archery
Crafts
Drama
Fire Building/Scavenger Hiking
Organized Sports (Soccer, Basketball)
High Ropes/Climbing Wall
Cookie Decorating
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Cabin Mates
Use this section to request to be paired with a family member or friend that has also been referred.
Name
First Name
Last Name
Birth Date
-
Month
-
Day
Year
Date Picker Icon
Relationship
Name
First Name
Last Name
Birth Date
-
Month
-
Day
Year
Date Picker Icon
Relationship
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School Information
School Name
*
School Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Last Year of School Completed
Please Select
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
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Family Information
Parent/Guardian's Name
*
First Name
Last Name
Relationship:
*
Contact Phone Number:
*
Secondary Phone Number
*
Please enter a valid phone number.
E-mail Address:
*
example@example.com
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Emergency Contact Information
If different from Parent/Guardian
Emergency Contact Name
First Name
Last Name
Relationship
Emergency Contact Phone Number
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Community Referral For Attending This Camp
Referring Community Member
Biological parents registering a child will require a community member from the list below to sign off as the referral. If the individual registering a child is a foster parent, please fill out either Guardian or Referral with the social worker's information, then that is a sufficient community member referral.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Title or Occupation:
*
Please Select
Foster Parent
Social Worker
School Official
Therapist
Coach/Teacher
(Family Members registering their camper will require one of the options below to also sign off on the referral)
How long have you known the individual being registered for camp?
*
Please describe your reasons for referral to Camp Silver Lining
*
0/300
Any diagnoses, health concerns, or behavior issues that camp staff should be aware of that may impact the camp experience?
Do you wish to be contacted for follow up on this referral?
Yes
No
Signature
*
Submit Form
Submit Form
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