Author/Illustrator Camp Sign Up
July 23-27, 9am - 3pm
Emmanuel Episcopal Church, Alexandria VA
For any questions, please email courtney@pippinmathur.com
Email address *
Name of Child *
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Age of Child *
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Parent Name *
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Address 1 *
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Address 2
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City *
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State *
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Zip Code *
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Home Phone *
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Alternate Phone Number *
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Emergency Contact Name *
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Emergency Contact Phone Number *
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Authorized Adults *
Please list all adults who are authroized to pick up for your child from camp. List in the format of (Name) - (Relation).
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Additional Information
Please provide any other important information, especially concerning allergies or medication requirements.
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A copy of your responses will be emailed to the address you provided.
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