Parent Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Child Name *

First Name

Last Name

Gender *

Female

Male

Grade child will complete at the end of this school year *

Kindergarten

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

Does your child have any allergies? *

Yes

No

Will your child need to take medication during their time at camp? *

Yes

No

Emergency Contact 1 *

First Name

Last Name

Emergency Contact 1 Phone Number *

(###)

###

####

Emergency Contact 2

First Name

Last Name

Emergency Contact 2 Phone Number

(###)

###

####

I give permission for you to take my child’s photo during camp. *

Yes

No

I give you permission to utilize my child’s photo for promotional use on the website, in print and on social media. *

Yes

No

I have read and agree to the terms of the liability & medical waiver (If you missed it, see Camp information page for full waiver.) *

Yes

No