Outlife Summer Camp Registration Form

Outlife Summer Camp Registration Form - Bangalore - 30 April - 04 May 2025

Please fill all the details below
Full Name of the Child*
Date of Birth

DayMonthYear
Age(in years)
FemaleMaleOther
Blood Group*
No Known AllergiesNuts (Please Specify Below)ChocolatesProcessed FoodsSoyRed DyeMilkCurdPollenDustMitesBees & WaspsMosquitoesFruits & Vegetables (Please Specify Below)Others (Please Specify Below)
Please Specify
No Known ConditionsAsthamaEpilespyAutismADHDODDHyperactivityInattentionDefianceAggressionImpulsivityAny Other Condition (Please Specify Below)
Please Specify/Elaborate
Please mention any behaviours of the child that may need special care
Please mention any issue/condition based/regular medicine that the child has to take during the camp. Please mention the name, dosage and frequency of the medicine and where it is kept/stored in the bag(and any support needed from the facilitators side)
Please Note: For children with any Medical / Behavioural Condition, must provide a doctor's certificate mentioning that the child can attend the outdoor summer camp for a week.
Father's Name*
Father's Mobile Number*
Mother's Name*
Mother Mobile Number*
Guardian's Name
If Guardian is Registering the Child
Guardian's Mobile Number
If Guardian is Registering the Child
Guardian's Relationship with the child
If Guardian is Registering the Child
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please list the Name & Number of the person who has permission to pick the child up (if other than parent/Guardian) from the camp on the last day
Emergency Contact Name*
Emergency Contact details other than Parent/Guardian
Emergency Contact Number*
Emergency Contact details other than Parent/Guardian
Family Doctor Name
Family Doctor Number
Medical Insurance Company
Medical Insurance Number
Date*

DayMonthYear
Signature*

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Outlife Summer Camp Registration Form - Bangalore - 30 April - 04 May 2025