BYA Summer Camps 2017 Registration
Please fill out all requested information to help us prepare adequately for the camps from July 26 to 30 of 2017
Parent Information
Please fill out your contact information for all of your registered children
First Name *
Your answer
Last Name *
Your answer
Email Address *
Your answer
Re-enter Your Email Address *
Your answer
Mailing Address *
Number, Street, City, State, Zip Code.
Your answer
Phone Number *
Your answer
Emergency Contact Information for all campers registering below: *
Please list TWO (2) people including parents or relatives available for emergency contact during our camp time (July 23 to 30)
Your answer
Please list Name and Phone number of the Family Doctor for medical emergency if needed
Your answer
If you are interested in using the Van Pool service for transportation to camp with additional fee, please indicate your need:
Registration Info for Camper Number 1
If parents are accompanying children, please input your information here AGAIN as Adult Camper.
Camper1 - First Name *
Your answer
Camper1 - Middle Name
Your answer
Camper1 - Last Name *
Your answer
Camper1 - Date of Birth *
Your answer
Camper1 - Gender *
Is this camper a regular participant of iMAP and/or BYA programs? *
Which camp will this camper be attending? *
Please list any special medication condition of this camper that Camp Staff should be aware of: *
Your answer
Please list any allergies or reactions to certain food and/or medicine for this camper: *
Your answer
Please list any special condition or instruction that might limit this camper's participation in certain physical activities: *
Please be specific if there are outdoor and/or physical activities this camper NOT to be engaged.
Your answer
Would you like to register for another camper? *
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