Kids Camp: Fire Experience 2018 Registration Forms
Please make sure to complete EACH page of these forms in order to register your child for the Kids Camp: Fire Experience program. This years dates are Friday, August 24 and Saturday, August 25. Parents MUST stay with the children on Friday evenings.

Kids Camp: Fire Experience is a FREE event thanks to our community sponsors. This year we lost one of our larger sponsors and are asking for a $5.00 donation per each child registered to help cover the basic costs of the camp. THANK YOU!!!

Child's Name *
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
Child's Age *
ALL CAMPERS MUST BE BETWEEN THE AGES OF 5 AND 14
Parent/Guardians Name *
Your answer
Street Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Home Phone Number *
Your answer
Parent/Guardian Work Number *
Your answer
Parent/Guardian Cell Phone Number *
Your answer
Email Address *
Lot's of our information will be delivered via email, so please make sure to include a valid email. IF YOU DO NOT HAVE EMAIL, PLEASE WRITE N/A
Your answer
Child is being registered for the following dates: *
Please select your child's shirt size *
Camp Participants ONLY)
Parent/Guardian Contact Number (In Case of Emergency) *
We require that all parent/guardians be available by phone in case we would need to contact you.
Your answer
Emergency Contact (Other than Parent/Guardian) Name *
Your answer
Relationship to Child *
Your answer
Emergency Contact Phone Number *
Your answer
Family Physician Name *
Your answer
Family Physician Contact Number *
Your answer
Preferred Hosptial *
Christiana Community Ambulance will be on location each day
Your answer
Medical Conditions *
Please list any conditions that we should be aware of that impact your child (ex. Asthma, ADHD, etc.)
Your answer
Please list any allergies that your child has *
Medical (ex. Penicillin) and Environmental (ex. Dust, Milk, Grass, etc.)
Your answer
Is there anyone that your child would want to be with during the Kids Camp on Saturday? *
Please type in the name(s) and we will do our best to see if we can work out the groups to accommodate this request.
Your answer
IT IS THE RESPONSIBILITY OF ALL PARENTS/GUARDIANS TO PROVIDE ADEQUATE MEDICAL INSURANCE FOR PARTICIPANTS. TYPING YOUR NAME BELOW INDICATES YOU HAVE PROPER MEDICAL INSURANCE COVERAGE. *
(Please type your full legal name - this will act as your electronic signature)
Your answer
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