Goshen Friends School Summer Camp 2019
Please fill out the form below to register for Goshen Friends School's 2019 Summer Camp program. This form must be completed before your child can participate in our summer program.

PLEASE NOTE: If you have multiple children attending camp, you must fill out a form for each child.

We're looking forward to a fun-filled summer with your child! If you have any questions about this form, please email Michele Kornegay at michele.kornegay@goshenfriends.org.

1. Name of camper: *
Your answer
2. Camper's date of birth: *
Your answer
3. School that camper will be entering in the fall: *
Your answer
4. Main parent/guardian contact, name: *
Your answer
5. Main parent/guardian contact, address: *
Your answer
6. Main parent/guardian contact, daytime phone number: *
Your answer
7. Main parent/guardian contact, email address: *
Your answer
8. Parent/guardian #2, name: *
Your answer
9. Parent/guardian #2, daytime phone number: *
Your answer
10. Emergency contact #1 (person who can be contacted if neither parent can be reached), name: *
Your answer
11. Emergency contact #1, daytime phone number: *
Your answer
12. Emergency contact #1, relationship to camper: *
Your answer
13. Emergency contact #2, name: *
Your answer
14. Emergency contact #2, daytime phone number: *
Your answer
15. Emergency contact #2, relationship to camper: *
Your answer
16. Camper's physician's name: *
Your answer
17. Camper's physician's phone number: *
Your answer
18. Camper allergies (if none, please indicate): *
Your answer
19. Other relevant medical information (diabetes, epilepsy, eye/ear problems, any chronic conditions) (if none, please indicate): *
Your answer
20. Immunizations (this information must be on file in the Goshen Friends School office in order for your child to participate in summer programs): *
21. Emergency care consent (this box must be checked): *
Required
22. Billing contact, name (if same as main parent/guardian, please indicate): *
Your answer
23. Billing contact, address (if same as main parent/guardian, please indicate): *
Your answer
24. Billing contact, email address (if same as main parent/guardian, please indicate): *
Your answer
25. Billing contact, phone number (if same as main parent/guardian, please indicate): *
Your answer
26. Please bill me: *
27. Photo release: *
28. Please choose your camper's program/programs: *
Required
29. How did you find out about Goshen Friends School's Summer Camp? *
Your answer
30. Payment policy (this box must be checked): *
31. Refund policy (this box must be checked): *
Required
32. Date application submitted: *
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