Craft Camp Registration Form

Summer Camp Registration
CHILD INFORMATION:
Child Name*

First NameLast Name
Birth Date*

MonthDayYear
Age*
Name of School and grade*
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail*
example@example.com
Relationship to Camper*
Emergency Contact
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
MEDICAL INFORMATION
Physician Name*

First NameLast Name
Phone Number*
Medical Concerns*
T-Shirt Size: Please choose size and youth or adult.*

XSSmallMediumLargeX-LargeXX-LargeYouthAdult
Permissions
I give permission form child's photo/video to be taken and used for promotional purposes.*

YesNo
I understand that participation in camp activities involves risk, and I release Roses with Wings, its staff, and volunteers from any liability for injuries or accidents.*

I agree
Signature
Name*

First NameLast Name
Signature*

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Summer Camp Registration