Camper Name * First Name Last Name Age * Birthday (D/M/Y) * Gender * Male Female Phone * (###) ### #### Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Parent / Legal Guardian * First Name Last Name 6 digit Medical Number * 9 digit medical Number * Is there any medical issues we should know about Is the Child currently receiving any medicatin? If Yes, what medication? Is the child allergic to any medication, food, ect? If yes, please state name & type of reaction Do we have your permission to authorize medical treatment by a doctor? * Yes No In case of emergency please list one person, other than a parent, to be contacted * Number * Comments or additional Information we should know Date of completing application * MM DD YYYY Thank you! Your registration is complete. We look forward to seeing you at camp! Junior Weekend Camp Registration Form(Oct 4-6 2024)Ages 8-12
