• Day At The Museum Camp Registration Form

    These forms are required for your children to attend camp.
  • Camper's Information

  • Date of Birth*
     - -
  • NOTE - Children need to have completed Third Grade before they are eligible to participate in day camp. 

  • Parents' Information

    Parent/Guardian 1
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Where would you like to be reached while your child is at camp?*
  • Heading

    Parent/Guardian 2
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Where would parent/guardian 2 like to be reached while your child is at camp?
  • Emergency Contacts/Authorized Pickup

    Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you.
  • Heading

    Emergency Contact #1
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Heading

    Emergency Contact #2
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Medical / Health Information

  • Format: (000) 000-0000.
  • Does your child have any food, medication or environmental allergies?*
  • Allergies? Check all that apply*
  • 0/150
  • Does your child’s allergy/allergies require child care staff to monitor child for symptoms, take action if a reaction occurs, or give emergency medication to your child?*
  • Does your child have a special health or medical condition?*
  • 0/150
  • Is your child currently using any medication, food supplement or medical food (such as electrolyte solution)?*
  • 0/150
  • If yes, does this medication, food supplement, or medical food need to be administered at the day camp?*
  • Does your child have any dietary restrictions, including those for medical, religious or cultural reasons?*
  • 0/150
  • Does this dietary restriction require a modified diet that eliminates all types of fluid milk or an entire food group?*
  • Statement of Understanding

  • Date Signed*
     - -
  • Should be Empty: