Camper's First Name *

Camper's Last Name *

Camper's Age *

Address *Limit 2000 Characters

Parent/Guardian Name/s *

Parent/Guardian Phone Number/s *

Emergency Contact Name *

Emergency Contact Phone Number *

Emergency Contact Email Address *

Physician’s Name *

Physician's Phone *

Does your child have any allergies (food, medication, environmental)? *Limit 2000 Characters

Does your child have any chronic medical conditions (e.g., asthma, diabetes, epilepsy)? *Limit 2000 Characters

Does your child take any medications regularly? *Limit 2000 Characters

Any dietary restrictions? *Limit 2000 Characters

Any physical limitations or activity restrictions? *Limit 2000 Characters

Has your child had any recent injuries or surgeries? *Limit 2000 Characters

Does your child have any special needs, behavioral concerns, or learning disabilities? *Limit 2000 Characters

Any concerns we should be aware of? *Limit 2000 Characters

In case of emergency, I authorize camp staff to seek medical treatment for my child. *

I understand that the camp is not responsible for lost or stolen items. *

I grant permission for my child’s photo/video to be used for promotional purposes. *

By writing YES below, I acknowledge that the information provided is accurate and that I agree to the terms outlined above. *