Kids Mountain Bike Adventure Camp Registration Form

Child's Name *

First Name Last Name

Preferred Name (if child has one) *

Gender *

Male Female

Birthdate *

Month Day Year

Age at Time of Camp (June 24-28) *

6 years old 7 years old 8 years old 9 years old 10 years old 11 years old 12 years old 13 years old 14 years old

We may chose to get shirts for the kids. Child's T-Shirt Size *

Child Medium Child Large Adult Medium Adult Large Adult Extra Large

If a sibling of this child is applying to camp, please tell us who that is.

First Name Last Name

If 2nd sibling is applying to camp, please tell us who that is.

First Name Last Name

Please Select the days your child will attend. If fewer than 5 days please include Monday or Tuesday.

Monday Tuesday Wednesday Thursday Friday

Mailing Address (for camp correspondence) *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Parent *

First Name Last Name

Best Phone Number *

- Area Code Phone Number

This phone is a:

Cell Phone Work Phone Home Phone (land line)

Parent Email Address *

Parent #2

First Name Last Name

Parent or Legal Guardian #2 Best Phone Number

- Area Code Phone Number

This phone is a:

Cell Phone Work Phone Home Phone (land line)

Parent/Guardian Two Email Address

Authorized people to pick up your camper if you will not be able to.

First Name Last Name

Cell Number For Authorized Adult

- Area Code Phone Number

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

Kids Mountain Bike Adventure Camp 2019

June 24-28, 2019 at Silver Lake Park, Salem, WI Camp is open to kids 6-14

DO NOT PRINT THIS APPLICATION...MUST BE FILLED OUT AND SUBMITTED ONLINE.

Questions

Photo

Fees

Child's Information

Siblings of Child Applying to Kids MTB Adventure Camp This Summer

Parent/Guardian Information

Your Child

Medical History + Prescription Medication Information

REQUIRED: Send a copy of child's insurance card to Angela.

Prescription & Over-the-Counter Medications

REQUIRED: Recent Color Photograph JPG ONLY...do NOT upload a PDF or other file type

After you have submitted this application, print the Brooks Adventures Release Forms found at the link below. We need paperwork with original signatures!

Kids Mountain Bike Adventure Camp 2019

June 24-28, 2019 at Silver Lake Park, Salem, WI Camp is open to kids 6-14

DO NOT PRINT THIS APPLICATION...MUST BE FILLED OUT AND SUBMITTED ONLINE.

Questions

Photo

Fees

Child's Information

Siblings of Child Applying to Kids MTB Adventure Camp This Summer

Parent/Guardian Information

Your Child

Medical History + Prescription Medication Information

REQUIRED: Send a copy of child's insurance card to Angela.

Prescription & Over-the-Counter Medications

**REQUIRED**: Recent Color Photograph ** JPG ONLY...do NOT upload a PDF or other file type **

After you have submitted this application, print the Brooks Adventures Release Forms found at the link below. We need paperwork with original signatures!

REQUIRED: Recent Color Photograph JPG ONLY...do NOT upload a PDF or other file type