Day Camp Information - Summer Camp 2020

Participant Information & Emergency Contacts

Question Title

* 1. Child's First Name?

Question Title

* 2. Child's Last Name?

Question Title

* 3. Child's birth date?

MM/DD/YYYY

Date

Question Title

* 4. Emergency Contact 1
(To be contacted in the case of an emergency should we be unsuccessful in contacting the parent / caregiver)

Name *

Address *

City/Town *

State/Province *

ZIP/Postal Code

Country

Email Address *

Phone Number *

Question Title

* 5. Emergency Contact 2
(To be contacted in the case of an emergency should we be unsuccessful in contacting the parent / caregiver)

Name

Address

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number