STARS CAMP Registration Form

STARS CAMP Registration Form

This form is required to attend STARS CAMP.
Camper's Information
Member ID
Camper Name*
Nickname
Date of Birth*

MonthDayYear
Age
Which School does the camper attend?
Grade in 2021/22*
Clothing Size
Camper Swimming Ability*

Non-SwimmerBeginner Swimmer (can swim on front 20ft without flotation)Advanced Swimmer (can pass swim test)
Please provide any additional information that you think is important or may affect the camper's ability to fully participate in the camp program.

Parents' Information

Parent/Guardian 1
Parent/Guardian 1*

First NameLast Name
Relationship to Child*
E-mail*
Cell Phone*
Home Phone*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent's Work*
Or enter N/A if not applicable
Parent's Work Phone
Parent's Work Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Where would you like to be reached while your child is at camp?*

Cell PhoneWork PhoneHome Phone
Parent/Guardian 2
Parent/Guardian 2*

First NameLast Name
Relationship to Child*
E-mail*
Cell Phone*
Home Phone*
Home Address Same as Parent/Guardian 1?

Yes
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent's Work Name*
Or enter N/A if not applicable
Parent's Work Phone*
Parent's Work Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Where would parent/guardian 2 like to be reached while your child is at camp?

Cell PhoneWork PhoneHome Phone

Emergency Contacts/Authorized Pickup

Parents cannot be listed as emergency contacts. List the name of one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be at least 18 years of age.
Emergency Contact
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Primary Phone Number*
Secondary Phone Number*
Relationship to Child*

Payment and Statement of Understanding
STARS CAMP has permission to secure emergency transportation for my child in the event of an illness or injury which requires emergency treatment. The emergency transportation service will determine the facility to which my child will be transported.*
Type first and last name above to consent
I have reviewed and received a copy of STARS CAMP INFORMATION BROCHURE*

YesNo
Sign Document*
Date Signed*

MonthDayYear
Should be Empty: