Camp Malchus STEM Registration
Email address *
Camper's Name: *
Your answer
Address: *
Your answer
Email address: *
Your answer
Parent Name: *
Your answer
Primary Phone: *
Your answer
Daytime Phone: *
Your answer
Mother's Cell: *
Your answer
Emergency Contact: *
Your answer
Emergency Number: *
Your answer
Emergency Contact Relationship: *
Your answer
Finishing Grade: *
Your answer
Birthday: *
MM
/
DD
/
YYYY
Primary Physician: *
Your answer
Physician's Number: *
Your answer
How did you hear about us? *
Your answer
Friend request: *
Your answer
Camper's School: *
Your answer
Did you download the Medical Form? *
Did you arrange for payment? *
Are you interested in the optional lunch program? *
Do you give the camp permission to take your son to 7 eleven? *
Do you give us permission to use pictures of your son on the website? *
Payment Method
Please email campmalchus@gmail.com when you have sent in 1/2 of your payment and emailed all three required medical forms(transport form and medical form on the website and half of your payment). At that point your registration will be complete.
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Myraj Media, LLC.