Camp Supplement Form - 2017
Welcome to Off The Wall Sports Summer Day Camp.

Please fill out this form completely and click "Submit" at the bottom. Campers will not be allowed to attend camp until the supplemental applications are submitted. No Exceptions!


Payment Policy

Your account must be paid in full upon arrival on the first day of the current camp week. It is your responsibility to make payments in a timely manner. You are required to keep a credit card on file with us or pay in full in advance. We will review payments on a daily basis. In the event a camper arrives for the first time during a week and is not paid in full for that week, we will automatically charge your credit card (on file) for the weekly balance. If we are unable to collect the full weekly charge in advance you might be denied attendance for future days in our camp.

If you require other payment arrangements, we are happy to help. Please advise in advance so that we can properly manage your account.

Child's First & Last Name *
Your answer
Primary Contact Name *
Parent/Guardian
Your answer
Primary Contact Phone Number *
Your answer
Primary Contact Email Address *
Your answer
Secondary Contact *
Parent/Guardian/Friend
Your answer
Secondary Contact Phone Number *
Your answer
Camper Pick-Up Information
In addition to the primary and secondary contact, I authorize the following people to pick up the above named child. Please list name and phone number for each name listed. Each person will be required to show a photo I.D. when they pick up the camper. Your cooperation is appreciated.
Your answer
Please list any allergies your camper may have.
Your answer
Is your camper allergic to any specific brands of sunscreen? *
If your camper is allergic to brands of sunscreen, please list the brands.
Your answer
Food allergies/restrictions. If yes, please list.
Your answer
Is your camper currently on any medications? If yes, please list.
Your answer
Does your camper have any medical afflictions we should know about? If yes, please list.
Your answer
Insurance Carrier
Your answer
Insurance Policy Number
Your answer
Family Physician
Your answer
Family Physician Phone Number
Your answer
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