Summer Camp Registration Confirmation

Thank you for completing Step #1 in the summer camp registration process!

What we need next from you:

Step #2: Submit the Medical Form below:

Name

In case of emergency the following person has my consent to authorize medical care for my children listed below:

First Name

Last Name

Child's Name

First Name

Last Name

Our Family Physician Is:

First Name

Last Name

Physician Address is:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Physician Phone:

(###)

###

####

Hospital Preference

List any allergies child may have:

Contact Me Immediately at this phone number:

(###)

###

####

If unable to contact me please call:

(###)

###

####

And/or this person:

(###)

###

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SIGNED BY: Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Date

YYYY