Summer Camp Wait list
Email address *
Your name *
Your answer
Your phone number *
Your answer
Your email address *
Your answer
Child's First Name *
Your answer
Child's Last Name *
Your answer
Grade camper is going into this fall? *
Child's birth date *
MM
/
DD
/
YYYY
Any pertinent medical information? *
Your answer
By filling this out I understand that food will be consumed during camp and I have disclosed my child's known allergies and medical information. (allergies, prescription medicine, etc.) *
Child's Primary Physician (Doctor Full name) *
Your answer
Physician's Phone Number *
Your answer
Health Insurance Carrier ** Please put full company name *
Your answer
Policy Number *
Your answer
Any Other Pertinent Information (Special Accommodations) *
Your answer
Who is allowed to pick up the child *
Your answer
Emergency Contact (Full Name) *
Your answer
Emergency Contact Relationship *
Your answer
Emergency Contact Phone Number *
Your answer
Have you read our Camp Policies and understand you will be automatically charged $15 per fifteen minutes past the pick-up time for your child’s camp. *
I give my permission to take photographs and/or videotape of my child. I understand that the photos and/or tape may be used for marketing purposes. There is no expiration date on this release and I will not seek compensation for usage. *
Which camp(s) wait list would you like to be added to?
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