2018 Tom Bass Camp Registration
June 18th – June 22nd
Hours: 9:00am – 3:00pm @ Murphey Candler Park
Email address *
Camper's Name *
Camper's grade *
Camper's Age *
Home Phone *
Cell Phone *
Returning Camper? *
Parent(s) Name(s) *
Parent(s) Email(s) *
Address *
Method of Payment *
Any info we should know about your child
Medical Insurance Carrier *
Medical Insurance Policy Number *
Are there any medical conditions that physicians should be aware of?
Emergency Contact Name (other then parent) *
Emergency Contact Phone (other then parent) *
Parent's Signature *
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