NewGen Camp M.A.D.E - Registration
Fill out the form carefully
Parent Information
Parent Information
Parent's Name
*
First Name
Last Name
Parent's E-mail
*
Home Number
-
Area Code
Phone Number
Cell Number
*
-
Area Code
Phone Number
Network
*
Please Select
Digicel
Lime
Camper Information
Camper Information
Camper's Full Name
*
First Name
Middle Name
Last Name
Date Of Birth
*
/
Month
/
Day
Year
Date Picker Icon
Today
-
Month
-
Day
Year
Date Picker Icon
Age
Gender
*
Please Select
Male
Female
N/A
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Camper's E-mail
Mobile Number
-
Area Code
Phone Number
School
Church
First Time Camper
*
Yes
No
If you are a first time camper please tell us how you heard about New Generation Camp:
New Generation would like your permission for your child to participate in the following:
Are you interested in being a counsellor at a NewGen Pod Camp?
Yes!
No, thanks
Maybe
Camp Information
Camp Information
Year
*
Please Select
2022
2021
2020
2019
Health Information
Health Information
Health History
Details
Medication to be given to camper
Any other important Information
Covid-19 Intake
If my child/children have any signs or symptoms of a respiratory infection such as fever, cough, shortness of breath, body aches or sore throat, I will not take them to camp
*
I Agree
Have you or any of your family members had any signs or symptoms of a respiratory infection in the past 14 days?
*
yes
no
Have you or your child/children traveled to a Covid-19 infected area recently?
*
yes
no
Have you come into close contact (within 6 feet) with someone with a laboratory-confirmed Covid-19 diagnosis in the past 14 days?
*
yes
no
Emergency Contact
Emergency Contact
Emergency Contact #1
*
First Name
Last Name
Home Number
-
Area Code
Phone Number
Work Number
-
Area Code
Phone Number
Cell Number
*
-
Area Code
Phone Number
Emergency Contact # 2
First Name
Last Name
Home Number
-
Area Code
Phone Number
Work Number
-
Area Code
Phone Number
Cell Number
-
Area Code
Phone Number
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