Day Camp Registration Form

Name

First NameLast Name

Birth Date

MonthDayYear

Age (at time of camp)

Grade (entering this fall)

T-shirt Size:

Blood Type

List Any Allergies and Dietary Restrictions

Medications & Frequency

Email

example@example.com

Phone Number

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name

First NameLast Name

Email

example@example.com

Cell Phone

Area CodePhone Number

Work Phone

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Occupation

Relationship with the Camper

Emergency Contacts and Authorized Pick Up Persons

Select Camp Week

Select Camp Type

Transportation

Select the closest location

Total Cost

Payment Type

Date

Signature