Cheer Camp Registration Form

Cheer Camp Registration Form
Date: July 15, 2019
Time: 9:00 AM
Location: Camp ABC - GYM D
1734 Whaley Lane, Menomonee Falls, WI, 53051
Notes:
-Lorem ipsum
-Please bring extra clothes
Camper Information
Camper Name
First NameLast Name
Age
Date of Birth
MonthDayYear
Date
Gender
Phone Number
Area CodePhone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
School Name
Grade/Level
T-shirt size
Extra SmallSmallMediumLargeExtra Large
Medical Information
Blood Type
Please let us know if you have any allergies, existing illnesses or any medical conditions.
Are you currently taking any medication? If yes, please provide the generic name and its purpose?

Parent/Guardian Details
Parent/Guardian Name
First NameLast Name
Phone Number
Area CodePhone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Emergency Contact Details
If parent/guardian cannot be reached.
Contact Name
First NameLast Name
Phone Number
Area CodePhone Number

Payment Details
Camp Fee: $49
Payment Method
CashCheckCredit Card
Acknowledgment, Authorization, and Waiver
This camper has my authorization to engage in the activities of the ABC Camp program.
I allow taking photography of this camper that can be used for Camp ABC portfolio or advertising.
I authorized ABC Camp to apply judgment in regards to medical assistance in the event of an accident, injury, or illness if they are unable to contact the parent/guardian. I allow them to apply first aid, medical or surgical diagnosis and treatment as necessary.
I allow ABC Camp to provide or administer the medication or supervise in self-administration.
I release ABC Camp and any of its coaches, staff, and manager for any responsibility in case of accident, illness, or injury during this camper's enrollment.
Date Signed
MonthDayYear
Date
Parent/Guardian Signature
Clear
CAMP ABC
1734 Whaley Lane, Menomonee Falls, WI, 53051
262-532-4174 - info@campabc.com - www.campabc.com
Should be Empty:

Camper Information