Student name
*
First Name
Last Name
Student Pronouns
Student Birthday
*
MM
DD
YYYY
Current Age & Grade
*
Student School
Summer Camp Session
*
Your name
*
First Name
Last Name
Your relation to child
*
Your email
*
Your phone number
*
(###)
###
####
Your address
*
Second adult contact name
*
First Name
Last Name
Second adult contact relation to child
*
Second adult phone number
*
(###)
###
####
Please list any additional adults authorized for drop-off and pick-up
Does your child have any food allergies, medical conditions, behavioral issues or special caretaking needs for us to be aware of?
*
yes
no
If yes, please include preferred course of action in the event something happens, including any specific doctors names and contact info.
Name of Doctor
First Name
Last Name
Contact information
