Camper Information
Name
*
First Name
Last Name
Age at time of camp
*
Allergies/Medication Conditions
Parent/Guardian Information
Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Please list authorized people to pick your child up after camp
Emergency Contact
*
First Name
Last Name
Emergency Contact Phone Number
*
-
Area Code
Phone Number
I authorize camp staff to have my child treated by qualified personnel if a medical emergency occurs
*
Yes
No
I give the Childrens Museum staff permission to include my child in photographs for Museum publicity purposes
*
Yes
No
As the child’s guardian/parent, I understand that if my child behaves in a manner that is unsafe or disruptive to the other companions, I will be notified and will need to pick my child up. (We make attempts at redirecting, however if the behavior continues, it is not fair to the other participants or teachers).
*
Camps
*
Payment
*
prev
next
( X )
Member
$
50.00
Number of Camps
1
2
3
4
5
6
7
8
9
10
Non-Member
$
60.00
Number of Camps
1
2
3
4
5
6
7
8
9
10
Total
$
0.00
Credit Card
Submit
Submit
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