Summer Camp Application
2020 Summer Camp
Email address *
Week Requested *
Required
Child's Name: Last, First *
Your answer
Age as of June 1st: *
Your answer
Date of birth: *
MM
/
DD
/
YYYY
Parents: *
Your answer
Address: City, State, zip *
Your answer
Primary Phone: *
Your answer
Secondary Phone:
Your answer
Pediatrician: Name & Phone # *
Your answer
Does your child have allergies? Please list.
Your answer
Emergency Contact #1: *
Your answer
Emergency Contact #2:
Your answer
Persons NOT authorized to pick up my child:
Your answer
In the event that I can not be reached, I give Reveille permission to transport my child to a hospital if necessary and obtain medical treatment for my child named above. *
Required
All children must have proof of a current immunization record and have had a physical exam within a year of the first day of camp. The state also requires that we see your child's original birth certificate before he/she attends camp if we do not already have one on file.
Your answer
Payment *
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