Town Rec Camper's Information
Email *
Camper's Name (First and Last) *
Gender *
Camper's Date of Birth *
MM
/
DD
/
YYYY
Campers Age *
What is the grade the camper will be entering? *
Address *
Town *
Zip Code *
Parent/Guardian 1 (First and Last Name) *
Parent/Guardian 1 - Email *
Parent/Guardian 1 Cell Phone *
Parent/Guardian 1 Work Phone
Parent/Guardian 2 (First and Last Name)
Parent/Guardian 2 - Email
Parent/Guardian 2 Cell Phone
Parent/Guardian 2 Work Phone
Child Resides With *
Additional Emergency Contact Name (Will be included on the Approved Pick Up List) *
Emergency Contact Cell Phone *
Emergency Contact Home Phone
Emergency Contact Relationship *
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