Child's Full Name *
Child's Full Name
Birth date *
Birth date
Parent/Guardian 1 Name *
Parent/Guardian 1 Name
Address *
Address
Phone (Home) *
Phone (Home)
Phone (Mobile) *
Phone (Mobile)
Parent/Guardian 2 Name
Parent/Guardian 2 Name
Address 1
Address 1
If different from above
Phone (Home)
Phone (Home)
Phone (Mobile)
Phone (Mobile)
Pick-Up/Release Contact *
Pick-Up/Release Contact
To whom the child will be going at the end of each day's session, ID will be required
Phone *
Phone
Additional Information
Emergency Contact 1 *
Emergency Contact 1
Emergency Contact 2
Emergency Contact 2
Phone
Phone
Any medication that needs to be given during the camp session needs to come in labeled clearly with directions and the camper’s name. Medication will be returned each day directly to the pick up adult