Kids Camp Registration Form

Child's Name *

First

Last

Parent/Guardian Name *

First

Last

Contact Information

Physical Address *

Address Line 1

Address Line 2

City

State

Zip Code

Physical address same as mailing address? *

Yes
No

Best Phone Number *

Email *

Age Information

Child's Birth Day *

Age: *

Medical Information

Medical or other information we need to know. (Please include any food allergies.)

Emergency Contacts (other than listed above)

Name

First

Last

Phone

Would you like to add another emergency contact?

Yes
No

Other Information

May we have permission to photograph your child? *

Yes
No

Parent/Guardian Signature *

Clear Signature