"I Spy" Art & Music Camp Registration Form (Day Camp for 5 to 13 year olds with traumatic brain injury, cerebral palsy, and physical or cogitive disabilites)
Welcome to the application process for the Aiken Center for the Art's TBI Camp 2017. All of the information requested is very important to us - not only to determine if this camp is the right camp for your camper, but also to help us in caring for your child while they are at camp if they are accepted. We need all the details on your child to ensure their safety. Your camper's instructor will use the information you provide as an aid at camp - please take the time to give us complete answers! If you are unsure how to answer or have any questions please e-mail Cathy Rumble at cathy.rumble@aikencenterforthearts.org
How did you hear about this camp?
Your answer
CAMPER'S last name
Your answer
CAMPER'S first name
Your answer
Name CAMPER wishes to be called
Your answer
Date of birth
MM
/
DD
/
YYYY
Age (at camp)
Your answer
PARENT or GUARDIAN full name
Your answer
Street address
Your answer
City
Your answer
State
Your answer
Zip code
Your answer
County
Your answer
GUARDIAN'S home phone
(please give us alternative phone numbers, as we need more than one way to contact you while your child is at camp.)
Your answer
GUARDIAN'S cell phone
(please give us alternative phone numbers, as we need more than one way to contact you while your child is at camp.)
Your answer
GUARDIAN'S work phone
(please give us alternative phone numbers, as we need more than one way to contact you while your child is at camp.)
Your answer
GUARDIAN'S email address
Your answer
Emergency contact's NAME
Your answer
Emergency contact's RELATIONSHIP TO CAMPER
Your answer
Emergency contact's PHONE NUMBER 1
Your answer
Emergency contact's PHONE NUMBER 2
Your answer
Name(s) of individuals allowed to pick-up camper
Your answer
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