Science - Camp Registration Form

Camper's Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Grade Camper is Entering*

Camper's Age*

School Camper Will Be Attending*

Parent/Guardian Information

Name*

First NameLast Name

Phone Number*

Format: (000) 000-0000.

Additional Phone Number*

Format: (000) 000-0000.

E-mail*

example@example.com

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Emergency Phone Number*

Format: (000) 000-0000.

Physician Information

Physicians Name*

First NameLast Name

Physician's Phone Number*

Format: (000) 000-0000.

Does the camper have any allergies? If yes, please specify.*

Media Consent and Acknowledgement: I give EDW permission to publicly use pictures that may include my child through the school’s website, social media, and publications.*

Informed Consent and Acknowledgement: By submitting this form, I hereby give permission for my child to attend EDW Summer Camp. As parent/guardian, I do hereby authorize the treatment by a qualified and licensed medical doctor in the case of an emergency.

My Products*

Science Camp Registration Fee

$100.00

Enter coupon

Subtotal

$0.00

Shipping

$0.00

Total

$0.00

Credit Card

Camper Information

Credit Card

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