2020 FORT STEELE SUMMER CAMP FORM

FORT STEELE SUMMER CAMP FORM

2020 Day Camp
Days Attending Camp *

July 13th July 27th August 17th July 14th July 28th August 18th July 15th July 29th August 19th July 16th July 30th August 20th July 17th July 31st August 21st July 20th August 10th August 24th July 21st August 11th August 25th July 22nd August 12th August 26th July 23rd August 13th August 27th July 24th August 14th August 28th
Child Information
Child Name *

First Name Last Name
GENDER *

MALE FEMALE
DATE OF BIRTH *

Month Day Year
Date Date Picker Icon
CARECARD NUMBER *
FAMILY PHYSICIAN
DOES YOUR CHILD HAVE ANY ALLERGIES? *

YES NO
LIST OF ALLERGIES AND REACTIONS (If Applicable)
DOES YOUR CHILD HAVE ANY OF THE FOLLOWING

ADHD ASD Developmental Delays
MEDICATION BEING TAKEN
CAN WE USE PHOTOS ON YOUR CHILD IN OUR MARKETING? *

YES NO
PARENT/GUARDIAN INFORMATION
PARENT/GUARDIAN NAME *

First Name Last Name
PARENT/GUARDIAN PHONE NUMBER *

Area Code Phone Number

ADDRESS *

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FORT STEELE SUMMER CAMP FORM