Day Camp K-2nd Grade

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Newsletter Spring 2010

Day Camp K-2nd Grade (July 5-8)

Note: Camper's family insurance plan is the primary source of coverage for accidents.

Camper Name:
Gender:
Age:
Grade in the Fall:
Home Phone:
Mailing Address:
Father's Cell Phone:
Mother's Cell Phone:
Parent/Guardian Email:
Emergency Contact Name:
Emergency Contact Home Phone:
Emergency Contact Cell Phone:
Emergency Contact Relation:
Insurance Carrier:
Primary Insured:
Policy Number:
Family Physician:
Family Physician Phone:
Date of last Tetnus shot:
Current Medications and dosage:
Allergies:
Dietary and Special Needs :
Activity Restrictions:
Swim Skill Level:
Camp Attendance:
Please send me a camp newsletter:
Yes, my child's photo can be used in promotionals: