Summer Camp Detailed Registration Form

Summer Camp Registration
Camper Information
Campers Name

First NameLast Name
Birth Date

MonthDayYear
Grade
Gender
Campers Name #2

First NameLast Name
Birth Date - Camper 2

MonthDayYear
Grade
Gender Camper #2
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Home Number
Format: (000) 000-0000.
Cell Number
Format: (000) 000-0000.
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe. If No please put N/A
Is the child prescribed an inhaler? If yes, please explain any instructions.
Informed Consent and Acknowledgement

I, the parent/guardian of the above child name, hereby give my full consent for my child to participate in all activities associated with Loving Hands #2 Summer Camp, including but not limited to on-site activities and off-site field trips.

I understand and acknowledge that:

My child may be transported by Loving Hands #2 Summer Camp staff or authorized transportation providers from the camp facility to designated field trip locations and back.

All reasonable precautions will be taken to ensure the safety of my child during transportation and field trip activities.

I am responsible for ensuring that my child adheres to the rules and guidelines set forth by the camp staff while attending field trips.

I will inform the camp administration of any medical conditions, allergies, or special needs that may require attention while my child is in attendance.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date

MonthDayYear
Date
Signature

My Products

Registration

$50.00 Quantity

Total

Payment Methods

Credit Card

Apple Pay

Google Pay

Cash App Pay

Should be Empty:

Summer Camp Registration

Camper Information

My Products*

Payment Methods

My Products