CAMP REGISTRATION FORMS

Fill out the form below, or download this Document and print it out to sign.

Camper Name *
Camper Name
Child
Camp Selection *
Address *
Address
Child's Home Phone *
Child's Home Phone
Parent/Guardians - Contact Information
Parent/Guardian #1 *
Parent/Guardian #1
Address 1 *
Address 1
Home Phone *
Home Phone
Cell Phone
Cell Phone
Work Phone
Work Phone
Parent/Guardian #2 *
Parent/Guardian #2
Address 2 *
Address 2
Home Phone *
Home Phone
Cell Phone
Cell Phone
Work Phone
Work Phone
Emergency Contact #1 *
Emergency Contact #1
Home Phone *
Home Phone
Cell Phone
Cell Phone
Work Phone
Work Phone
Emergency Contact #2 *
Emergency Contact #2
Home Phone *
Home Phone
Cell Phone
Cell Phone
Work Phone
Work Phone
Medical Release Information
Insurance Information
Insurance Phone
Insurance Phone
The purpose of the above listed information is to ensure that medical personnel have details of any medical problem which may interfere with or alter treatment.
In case of medical emergency contact:
Contact #1 *
Contact #1
Phone # *
Phone #
Contact #2
Contact #2
Phone #
Phone #
Contact #3
Contact #3
Phone #
Phone #
Parent’s/Guardian’s Initials
Parent’s/Guardian’s Initials
Terms of Agreement
Parent’s/Guardian’s Initials
Parent’s/Guardian’s Name (Signature)
Date *
Date