General Reg. Form

Registration Form

* Indicates required field

Family Information

Parent’s Name *

First

Last

Address *

City *

Zip *

Primary Phone *

Emergency Phone *

Email *

Any learning accommodations that we should be aware of? Any food or insect allergies? *

Additional Comments or Requests *

Participant(s)’ Information

Child’s Name *

First

Last

Age *

Date of Birth *

Program *

Policies & Procedures read here

I have read the Policies & Procedures *

Agree

Waivers & Agreements read here

I have read the Waivers & Agreements *

MEDICAL RELEASE: I fully realize that injury or illness to my child may result from or during participation in the youth camp. In case of injury or illness, I give permission for my child to be given medical treatment as deemed appropriate. I further give permission for the information provided on this form to be shared with appropriate medical personnel. I further give permission for and grant authority to the camp representatives to sign on my behalf the Notice of Privacy Practice that patients are required to receive in accordance with federal law. I understand and acknowledge that I will be responsible for any medical bills incurred by my child.

I agree to the Medical Release *

Submit Your Registration

Registration Form

Family Information

Participant(s)’ Information

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