Peace Village Registration
Register your child(ren) for Peace Village 2019--if you are registering one child, please scroll past the Child 2 and Child 3 boxes.
Email address *
Adult's Name *
Your answer
Home address *
Your answer
Phone Numbers (home, cell, work--please list the numbers where we can find you during camp hours: 9am--12pm) *
Your answer
Child's Name and Birthday (1) *
Your answer
Check all that apply to your child *
Required
Please explain any of the above (skip if N/A)
Your answer
Please list any allergies (bee sting, food, medications) *list N/A if applicable *
Your answer
Please share any information about allergies, including and especially whether your child uses an Epipen
Your answer
Child's Name and Birthday (2)
Your answer
Check all that apply to Child 2
Please explain any of the above (skip if N/A)
Your answer
Please list any allergies for Child 2 (bee sting, food, medications) *list N/A if applicable
Your answer
Please share any information about allergies, including and especially whether your child uses an Epipen
Your answer
Child's Name and Birthday (3)
Your answer
Check all that apply to Child 3
Please explain any of the above (skip if N/A)
Your answer
Please list any allergies for Child 2 (bee sting, food, medications) *list N/A if applicable
Your answer
Please share any information about allergies, including and especially whether your child uses an Epipen
Your answer
Emergency Contacts (please list two and include phone numbers for each) *
Your answer
People allowed to pick up your child (other than the adult/guardian listed above)--Name/Relationship/Phone Number *
Your answer
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