Summer 2021
Please fill out one form for each camper and click submit.
Name of Camper *
Age of camper as of June 1, 2021 *
Select Campus *
Sessions / Weeks Attending *
Please check off each week that camper(s) will be attending.
Required
Address: City, State, Zip Code *
Parent's Name(s) *
Cell Phone # *
Home Phone #
Email Address *
Emergency Contact Name & Relationship *
Emergency Contact Phone # *
Medical Information: Special medications / relevant information
Allergies
I authorize all medical and surgical treatment and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of treatment. This waiver applies only in the event that neither parent/guardian can be reached in the case of an emergency. *
I give permission for my child to go on field trips. I release MJ Sports Camp and individuals from liability in case of accident during activities related to MJ Sports Camp, as long as normal safety procedures have been taken. *
Notes:
Group Code
Please type in name to electronically sign this form *
Submit
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