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Camp Session #2 Form
Please enable JavaScript in your browser to complete this form.
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Step
1
of 3
Child Name
*
First
Last
DOB
*
Parent/Guardian Name
*
First
Last
Parent/Guardian Email
*
Parent/Guardian Phone
*
Emergency Contact Name
*
First
Last
Emergency Contact Phone
*
Which Camp Will Your Child Attend?
*
Select
Session 1 (July 11th - July 22nd)
Child T-Shirt Size
*
Select One
XS
S
M
L
XL
XXL
XXXL
Next
Is your child currently on any medication that needs to be taken during camp, including inhalers?
*
YES
NO
If yes, written permission from a parent or guardian will be necessary to accompany the medication and the medications must be self-administered.
Allergies (medication, foods, etc.)
*
Reply N/A if no known allergies
Emergency Release Authorization
*
I Agree
Emergency Release: Parent/Guardian Signature I give permission, in the event of an emergency, for first aid to be administered to my child and emergency medical treatment including transportation by ambulance to the nearest hospital, should it be necessary. I understand that every effort will be made to contact me.
Parent/Guardian Signature
*
Clear Signature
Emergency Release Authorization
Next
Stripe Credit Card
*
Card
Name on Card
Total
$ 0.00
Submit