Day Camp Registration Form

Day Camp Registration Form

Date

MonthDayYear
Date
Day Camp Registration

Iberia, Missouri
Participant Reservation
Participant Name

First NameLast Name
Gender
Birth Date

MonthDayYear
1 Day AFTER First Day of Day Camp

YearMonthDay
Date
Age - Days
Age at Day Camp

Participant Information
Participant Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Parent/Guardian Name
Relationship to Camper
Preferred Phone Number
Alternate Phone Number

Allergies & Behavior
Does participant have any allergies (food, drug or environmental)?
Please list all allergies and details below:
Is there a risk of anaphylaxis for any of the participant's allergies?
Will participant be bringing an Epi-Pen?
Are there any other behaviors or information that camp staff should be made aware of for your child?
Please provide details:

Email Confirmation
Email (confirmation and information will be sent by email)
Should be Empty: