CAMPER INFORMATION

Name

New Camper

Date of Birth

Address

Apt/Unit #

Age

City

State

ZIP Code

Sex

PARENT/GUARDIAN INFORMATION

Please note that the order of this contact information is the order we will attempt to reach you if needed.

Parent/Guardian #1

Name

Home Phone

Cell Phone

Business Phone

Email

Parent/Guardian #2

Name

Home Phone

Cell Phone

Business Phone

Email

EMERGENCY CONTACT INFORMATION

Emergency Contact Information ONLY in the event a parent can not be reached

Emergency Contact #1

Name

Home Phone

Cell Phone

Business Phone

Email

Relationship

Emergency Contact #2

Name

Home Phone

Cell Phone

Business Phone

Email

Relationship

Camp Weeks

Check a box for each week you want your child to attend camp.

Week 1 6/24 - 6/28

Week 2 7/1 - 7/5

Week 3 7/8 - 7/12

Week 4 7/15 - 7/19

Week 5 7/22 - 7/26

Week 6 7/29 - 8/2

Week 7 8/5 - 8/9

Week 8 8/12 - 8/16

Week 9 8/19 - 8/23

Registration Fees

(1-3 weeks $350 per week) // (4-6 weeks $320 per week) // (7-9 weeks $290 per week)
2nd child discount -$20.00 per week

Early registration fee (on or before April 30)

Regular registration fee (May 1 through May 31)

Late registration fee (June 1 and later)

$25.00

$35.00

$50.00

Medical Documentation

Check if your child in general good health?

If not checked, please explain

Are there any known allergies or drug sensitivities? (Peanuts, Penicillin, etc.)

If any allergies listed, will an epi-pen be provided?

Check if your child has asthma or any condition that should limit physical exertion?

If asthma or any condition checked, will an inhaler be provided?

Check if your child wears glasses or contact lenses?

Check if your child wears a dental appliance?

Check if your child is currently taking any medication prescribed by a physician?

If checked, will this medication need to be administered during camp hours?

Are there any special circumstances we need to be aware of to make your child’s camp day more enjoyable?

How did you hear about us

Up to date immunization records signed by your doctor/pediatrician must be provided BEFORE your child attends our camp program.

Signature and Submission

Signature

Camp Registration Form

Please fill out a separate registration form for each camper

CAMPER INFORMATION

PARENT/GUARDIAN INFORMATION

Please note that the order of this contact information is the order we will attempt to reach you if needed.

Parent/Guardian #1

Parent/Guardian #2

EMERGENCY CONTACT INFORMATION

Emergency Contact Information ONLY in the event a parent can not be reached

Emergency Contact #1

Emergency Contact #2

Camp Weeks

Check a box for each week you want your child to attend camp.

Registration Fees

Medical Documentation

Signature and Submission