Parent/Guardian Information *

First Name

Last Name

Primary Phone Number *

(###)

###

####

Alternate Phone Number

(###)

###

####

Home Adress

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Camper Information *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Emergency Contact Information *

First Name

Last Name

Emergency Contact Phone Number *

(###)

###

####

Alternate Emergency Phone Number

(###)

###

####

Photo/Video Release Consent *

"I give permission for my child's photo/video to be used for promotional purposes"

Yes

No

Medical Consent *

"In case of emergency, I authorize the camp to seek medical attention for my child"

Yes

No

Code of Conduct Agreement *

"I acknowledge i have reviewed the camp's behavior expectations with my child"

Yes

No

Liability Waiver Agreement *

"I understand and accept the terms of participation and liability waiver"

Yes

No

Date of Submission *

MM

DD

YYYY