Wait list for Wellcats for Life Summer Day Camp Registration Form July 8- August 2, 2019
Email address *
You must download, print and complete this form along with your online registration
Mail Completed form to:
Stacy Ribbeck
c/o Depew High School
5201 Transit Road
Depew, NY 14043
PARTICIPANT INFORMATION
Last Name *
Your answer
First Name *
Your answer
Gender *
Required
Age *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Grade in September 2019 *
Child's T shirt Size *
Your answer
Home Address *
Your answer
City *
Your answer
Zip *
Your answer
***Everyone will be required to show valid photo ID at pick-up***
Contact 1
Contact 1 name *
Your answer
Contact 1 Day Phone *
Your answer
Contact 1 Cell *
Your answer
Contact 1 Relationship *
Your answer
Contact 2
Contact 2 Name
Your answer
Contact 2 Day Phone
Your answer
Contact 2 Cell Phone
Your answer
Contact 2 Relationship
Your answer
Emergency Contact
Emergency Contact name *
Your answer
Emergency Contact Relationship *
Your answer
Emergency Contact Phone *
Your answer
Additional individual #1 authorized to pick up my child(ren):
Name
Your answer
Relationship
Your answer
Phone number
Your answer
Additional individual #2 authorized to pick up my child(ren):
Name
Your answer
Relationship
Your answer
Phone number
Your answer
Additional individual #3 authorized to pick up my child(ren):
Name
Your answer
Relationship
Your answer
Phone number
Your answer
Submit
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