MASS Summer Camp Registration

Camper Name

Camp Dates: June8th-July24th
Last Name
First Name
Middle Name
Gender
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?
Are immunications up to date?
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
Signature
Electronic signature, please initial
Summer Camp Registration Camp Dates: June8th - July24th Camp Hours: 730am - 530pm *Closed June30th - July4th Camp Weekly Tuition: $150

107 Dotson Street Rock Hill SC 29732
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Camp tshirt NONREFUNDABLE $15.00

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Registration $100.00
$100 registration after April 1st Spaces are very limited, register today!

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- 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.
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Camper Name

Parent or Legal Guardian Information

Email Confirmation

Other Information

Camper Release

Summer Camp Registration Camp Dates: June8th - July24th Camp Hours: 730am - 530pm *Closed June30th - July4th Camp Weekly Tuition: $150

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