Camp Registration form- Please return with check
Name of Camper: ______________________________Age:________

Address:______________________________________________________
_____________________________________________________________

Moms Name: ______________________________
Phone: (Home) ___________________________
(Cell) ___________________________
Dads Name: ______________________________
Phone: (Home) ___________________________
(Cell) ___________________________
Please put a circle around which parent the child lives with if child does not live with both parents.

Any knows allergies?
_____________________________________________________________
_____________________________________________________________

Medical concerns including treatment:
_____________________________________________________________
_____________________________________________________________

Emergency contact if parents can not be reached:
Name: ___________________________________
Relationship: ___________________________
Phone: __________________________________




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