MASS Summer Camp Registration

Camper Name
Last Name*
First Name*
Middle Name*
Gender*

MaleFemale
Birth Date*

MonthDayYear
Emergency Contact Name(if parent or guardian is not avaliable)*
Emergency Number*

Area CodePhone Number
Emergency Number #2

Area CodePhone Number
Parent or Legal Guardian Information
Parent/Legal Guardian*
Relation*
Work Phone*

Area CodePhone Number
Cell Phone

Area CodePhone Number
Relation 2
Parent /Legal Guardian 2
Work Phone 2

Area CodePhone Number
Cell Phone 2

Area CodePhone Number
Email Confirmation
Parents Email (camper confirmation will be sent by email, if left blank it will be mailed)*
It is our policy to contact the parent or guardian as soon as possible in the event of a serious accident or injury.
Other Information
Is camper free from infectious desease or conditions?*

YesNo
Are immunications up to date?*

YesNo
Any physical, mental or other condition that would require special attention or medication while at camp?*
All fileds are required below. If nothing applies, please put "NONE" in the box. Thanks.
Any activity the camper should be restricted from?*
List any past medical treatment that would be helpful for us to know.*
List any allergies (ex: bees,peanuts, dairy)*
Any dietary needs that we should know about?*
By hitting submit and signing, you agree that you are the parent or legal guardian of the above named camper, and are over the age of 18. In case of medical emergency or general medical care, I give consent for medical teatment for the aboved named camper by authorized personnel. The camp carries secondary insurance. I understand that the above named camper will only be released to the names listed above, an update may be done at registration. I certify that my child has my permission to attend camp and participate in all activites. Right Choice camp or staff is not responsible for any accidents or injuries on or off the premises. I authorize Right Choice to use my camper's picture, testimony, and video in any promotional material(web,print,or media) My child may recieve any e-mails from the camp.
Camper Release (List anyone, including parents, to whom your camper can be released)*
Camper Release
- Be certain to enter your email address correctly on the registration form to receive confirmation, registration fee information and open house dates via email with in 2 weeks.
My Products*
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Camp tshirt NONREFUNDABLE $10.00

QuantityKid Shirts

Registration $100.00

Total $0.00
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Signature*

Clear
Electronic signature, please initial*
Summer Camp Registration. Camp Dates: June 17th-August 2nd Camp Hours: 730am-530pm. *Closed July1st-5th. Camp Weekly Tuition: $120

2351 Leslie Highway Rock Hill SC 29730
Should be Empty:

Camper Name

Parent or Legal Guardian Information

Email Confirmation

Other Information

Camper Release

Summer Camp Registration. Camp Dates: June 17th-August 2nd Camp Hours: 730am-530pm. *Closed July1st-5th. Camp Weekly Tuition: $120