Registration Form
pd _______
Name: ________________________________________
Address: ______________________________________
Phone: _______________________________________
Birthdate: _____________________________________
Health Card #: _________________________________
Parents or Guardians Name: _______________________
Emergency Contact: _____________________________
Special Medical Condition, Diet, or Known Allergies:
______________________________________________
______________________________________________
______________________________________________
______________________________________________
Camp
_____ Sports, Games & Adventure Camp July 19 - 23
_____ Water Mania & Outdoor Adventure July 26 - 30
_____ Mystery Camp Aug. 9 - 13
_____ Before & (or) After Care Required
I _________________________________________ give my permission for ________________________________________
to attend and participate in the summer camp program
chosen above.
Parent's Signature: _______________________________