Camp Van Go! LLC
Registration for 2019 Summer Camp Van Go!
Week
Guardians/Parents MUST sign the Waiver of Liability form upon arrival the first day of camp.
Child's Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Grade as of Sept. 1, 2019 *
Your answer
School *
Your answer
Parent/Guardian's Name *
Your answer
Address *
Your answer
Phone Number Home and Cell *
Your answer
Email *
Your answer
Insurance Company *
Your answer
Insurance # *
Your answer
PCP and Phone Number *
Your answer
Allergies
Your answer
Medical Conditions
Your answer
Medications
Your answer
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