Camp Compo Emergency Info 2019
Please complete the following information as thoroughly and accurately as possible.
The information you provide will help us care for your child in the event of an emergency.
Email address *
Child's Last Name *
Ex. Smith
Your answer
Child's First Name *
Ex. John
Your answer
Upcoming Grade in September 2019 *
Weekly Attendance
Please check "YES" for all weeks that your child is ENROLLED in camp
(check "NO" if you are on the Wait List or not attending a given week)
Enrolled in Week 1? (June 24 - 28) *
Movies (Gr. K-2 Tuesday); Lake Compounce (Gr. 3 & 4 Friday)
Required
Enrolled in Week 2? (July 1 - 5) *
Animal Embassy 7/2; Fire Engine Pizza Truck 7/5
Required
Enrolled in Week 3? (July 8 - 12) *
Movies (Gr. K-2 Tuesday); Rockin' Jump (Gr. 3 & 4 Thursday)
Required
Enrolled in Week 4? (July 15 - 19) *
Featuring Bubble Mania (on site) Tuesday
Required
Enrolled in Week 5? (July 22 - 26) *
Carnival Day (on site) Thursday
Required
Enrolled in Week 6 (July 29 - August 2)? *
Rockin' Jump (Gr K-2 Tuesday); Bowling (Gr. 3 & 4 Thursday)
Required
Enrolled in Week 7 (August 5 - 9)? *
Lake Quassy (all grades, Wednesday)
Required
Contact Information
Please be sure to type phone numbers in carefully and correctly. If there is no information to share for a given question, please type in "none."
Home Street Address *
Ex. 175 Main St. (If you live in a town other than Westport please include the town, i.e.: 175 Main St., Norwalk)
Your answer
Home Phone Number *
Ex. 203-515-9036
Your answer
First Parent/Guardian's Name *
Ex. Jane Smith
Your answer
First Parent/Guardian's Work Phone *
Ex. 203-515-9036
Your answer
First Parent/Guardian's Phone *
Ex. 203-515-9036
Your answer
Second Parent/Guardian's Name *
Ex. Joe Smith
Your answer
Second Parent/Guardian's Work Phone *
Ex. 203-515-9036
Your answer
Second Parent/Guardian's Cell Phone *
Ex. 203-515-9036
Your answer
Emergency Contact Info And Medical Information
Please share any and all information with us that will help us care for your child and keep them safe.
Emergency Contact Name *
Other than parent/guardian and must be available during program hours.
Your answer
Emergency Contact Phone Number *
Your answer
Doctor's Name *
Ex. Dr. Feelgood
Your answer
Doctor's Phone Number *
Ex. 203-515-9036
Your answer
Allergies, Limitations, and Medications
Please bring in medications that your child would need during camp. They will be held by the lead counselor in your child's group.
Does your child have any known allergies? *
List Child's Allergies *
If your child does not have any known allergies, please type "none"
Your answer
Does your child have any physical limitations? *
List Physical Limitations *
If your child does not have any physical limitations, please type "none"
Your answer
Is your child currently on any medications? *
Please list the medications and the condition we should be aware of. *
If your child does not have any known medications, please type "none"
Your answer
Will your child be continuing this medication during the summer camp experience?
Carpooling is Encouraged
When picking up your campers it is helpful for you to state the grade they are entering in September.
List authorized names for child pick-up with phone and cell numbers *
Ex. John Doe 203-333-555; Sharon Jones 203-222-7777
Your answer
Read and check that you understand and agree. *
Checking this box serves as your electronic signature to the statement below.
Required
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