Camp Emerson 2021
Student's First Name *
Student's Last Name *
Grade level in 2021-22 *
Twin sibling attending Emerson? *
Elementary School/ Previous School *
Parent A (Last name, First) *
Parent B (Last name, First) *
Home Address *
Email Address *
How many parents will attend the Parent Session? *
Emergency Contact Name *
Emergency Contact Phone *
If your child takes any daily medication or has serious allergic reactions that require medication, please describe here and notify the main office before Camp Emerson. If not, leave blank.
Parent Electronic Signature *
Please enter your name below as your electronic signature
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