Outlife Summer Camp Registration Form - Hyderabad -04-08 June 2025
Please fill all the details below pertaining to the attending child.
Full Name of the Child
*
Date of Birth
-
Day
-
Month
Year
Age(in years)
Gender
*
Female
Male
Other
Blood Group
*
Does the child have any Allergies(Tick below)
*
No Known Allergies
Nuts (Please Specify Below)
Chocolates
Processed Foods
Soy
Red Dye
Milk
Curd
Pollen
Dust
Mites
Bees & Wasps
Mosquitoes
Fruits & Vegetables (Please Specify Below)
Others (Please Specify Below)
Please Specify
Does the child have any of the following Conditions:
*
No Known Conditions
Asthama
Epilespy
Autism
ADHD
ODD
Hyperactivity
Inattention
Defiance
Aggression
Impulsivity
Any 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
City
State / 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
*
-
Day
-
Month
Year
Signature
*
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