Camp Shemesh Camper Application

Camper Application
Child's Name

First NameLast Name
DOB

MonthDayYear
Date
Current School
Current Grade
List any allergies
Applying for weeks

1234
Add another camper
Name

First NameLast Name
Age
Current School
Current Grade
List any allergies
Applying for weeks (click all that apply)

1234
Add another camper
Child's Name

First NameLast Name
Age
Current School
Current Grade
List any allergies
Applying for weeks

1234
Family Information
Father's Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Mother's Name

First NameLast Name
Phone
Please enter a valid phone number.
Email
example@example.com
Pediatrician
Phone Number
Please enter a valid phone number.
Emergency Contact 1

First NameLast Name
Phone Number
Please enter a valid phone number.
Emergency Contact 2

First NameLast Name
Phone Number
Please enter a valid phone number.
Should be Empty: