Summer Camp

Repeat Registration

Camper's Full Name

Camper 2 Full Name

Primary Parents/Guardians Full Name

Primary Parent/Guardian Phone Numbers

Primary Parent/Guardian Email Address

Is the emergency contact the Primary Parent/Guardian?

Yes

If no, please provide the Emergency Contact Name and Phone Number

Emergency Contact Name

Emergency Contact Phone No.

Please Read and Check

Liability Waiver: I understand participation involves inherent risks and release [Camp/Organization Name] except in cases of gross negligence.

Behavior Policy: Repeated or severe behavior issues may result in dismissal without refund.

Parent/Guardian Signature or Type Full Name

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Date of Signature

Year

Month

Day