Team Randy Application Summer 2025
Please fill out this form in its entirety to apply for Team Randy, Summer 2025 Session.  An immunization record must be filled out and emailed to TeamRandy1985@gmail.com in order for the application to be complete.  Thank you! 
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Email *
Camper’s Full Name *
Date of Birth *
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Grade (Fall 2025) *
t-shirt size (adult)
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Home Address *
Parent/Guardian Name and Cell Phone *
Emergency Contact 1  (Name, Relation, and phone number) *
Emergency Contact 2  (Name, Relation, and phone number)
Photo Release:  Do you provide permission for Team Randy to use photographs of your child with or without his/her name and for any lawful purpose including, but not limited to: illustration, advertising, social media, and/or web content? *
Medical Information
The following information will allow us to provide the safest summer for the children.
Physician's Name and Phone Number
Preferred Hospital
Special Needs if applicable:
Special Education Classification if Applicable:
What is something important that we should know about your child to ensure he/she has a fun and productive summer? (Please include any known triggers to negative behavior and/or emotional response.)
What do you hope this teenager gains from Team Randy?
Recent Injuries/Surgeries:
Allergies:
Medications that would need to be administered during camp (please include time of day):
Consent for Medical:  State law requires parents to sign the statement (only exception being religious beliefs).  If you do not sign this statement, on the basis of religion, a separate waiver form must be signed. 
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Immunization form to be completed and sent via email.  
Immunization Record
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Submit
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