Camp Van Go! LLC
Registration for 2019 Winter 3 Day Camp Van Go!
In order to complete registration, please print and sign the Waiver of Liability. I will submit by: *
Child's Name *
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Date of Birth *
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DD
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YYYY
Grade as of Sept. 1, 2018 *
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School *
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Parent/Guardian's Name *
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Address *
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Phone Number Home and Cell *
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Email *
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Insurance Company *
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Insurance # *
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PCP and Phone Number *
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Allergies
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Medical Conditions
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Medications
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