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Summer Camp Registration Form
Please fill out one form per child attending camp
Child's Name *
Name to be used at camp *
Sex *
Date of Birth *
Child's Age *
Grade during current school year
Does your child have any allergies *
Address *
Best Phone Contact *
Mother's Name *
Mother's Cell Phone *
Mother-TEXT? *
Mother's E-mail Address *
Mother's Address *
Mother's Employer *
Mother's Occupation *
Mother's Work Phone *
Father's Name *
Father's Cell Phone *
Father-TEXT? *
Father's E-mail Address *
Father's Address *
Father's Employer *
Father's Occupation *
Father's Work Phone
Marital Status of Parents *
Other Children in the Family (not attending camp) *
Contacts if Parents cannot be reached (Emergency Contact) *
People Authorization to Pick Up your child *
Full Time or Part Time? *
If Part Time how many days a week will your child attend? If a set day every week please list days also
2021 Camp Dates *
Required
Hours attending camp *
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