Under the Sea Art Camp Registration Form

Under the Sea Art Camp Registration
Camper's Information
Last Name
First Name
Address
City
State
Zip
Gender
Birth Date

MonthDayYear
Grade entering in the fall
Please select a camp day
Parent or Legal Guardian Information
Parent/Legal Guardian
Relation
Cell Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Parent /Legal Guardian 2
Relation 2
Cell Phone 2

Area CodePhone Number
Work Phone 2

Area CodePhone Number
Emergency Contact Info
Emergency Contact Name(if parent or guardian is not avaliable)
Emergency Number

Area CodePhone Number
Emergency Number #2

Area CodePhone Number
Email Confirmation
Parents Email (camper confirmation will be sent by email)
Other Information
Health Information
Any activity the camper should be restricted from?
List any allergies (ex: bees,peanuts, dairy)
Any physical, mental or other condition that would require special attention or medication while at camp?
Any dietary needs that we should know about?
Each camper should pack their own lunch and afternoon snack.
Camper Photo Release
I agree that photos of my child can be taken to be used for camp social media purposes
Payment Information

$50 Registration Fee Due
Method of payment
- Be certain to enter your email address correctly on the registration form to receive confirmation via email.
By hitting submit and putting your initials, you agree that you are the parent or legal guardian of the above named camper, and are over the age of 18. In case of medical emergency or general medical care, I give consent for medical teatment for the aboved named camper by authorized personnel. I understand that the above named camper will only be released to the names listed above, an update may be done at registration. I certify that my child has my permission to attend camp and participate in all activites.
Electronic signature, please initial
Should be Empty:

Under the Sea Art Camp Registration

Camper's Information

Parent or Legal Guardian Information

Emergency Contact Info

Email Confirmation

Other Information

Health Information

Camper Photo Release

Payment Information