SUMMER 2018 CAMP REGISTRATION

CHILD INFORMATION
Name
Name
Date of Birth
Date of Birth
Entering 2018
Request one or more camp weeks and courses
Lunch, Extended care available at additional cost
PARENT INFORMATION
Name
Name
Address
Address
Home Phone
Home Phone
Cell Phone
Cell Phone
EMERGENCY CONTACT INFORMATION
Name
Name
Cell Phone
Cell Phone
MEDICAL INFORMATION
Doctor's Name
Doctor's Name
Doctor's Phone
Doctor's Phone