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Summer Camp Registration
In the spring of each year we hold Summer Camp Registration. You can use the attached Summer Camp Registration template to create your own registration document. If you decide to create your own Summer Camp Registration Form please include all the information that is on the template.

Free Sample Template
Format: Word PDF
# of Pages: 1
Printable: Yes

Summer Camp Registration TemplateForm 3184
Format: Word PDF
Category: School, Administration
Type: Registration

Summer Camp Registration

Child’s Name: __________________________________________________________________________________

School Grade: ________________________________ DOB: ___/___/_____ Gender: M / F

Address: ______________________________________________________________________________________

City: ____________________________________________ State: _____________ Zip: _______________________

Phone Number: ________________________________________________________________________________

Email Address: _________________________________________________________________________________

Preferred Camp Start Date: ___/___/_____

Any allergies and or physical restrictions? ___ Yes ___ No

If yes, please specify: ____________________________________________________________________________



Child’s Doctor: ____________________________________________ Phone: ______________________________

Insurance Company: _______________________________________ ID #: _________________________________

Insurance Phone Number: ________________________________________________________________________

Preferred Hospital: ______________________________________________________________________________

If there is an emergency we will make every effort to contact the parents at the number listed above. We will also try and contact the Doctor that is listed above. If we are unable to make contact with anyone at the above listed numbers, I do hereby give my permission to the Summer Camp to call a physician and secure proper emergency medical treatment while efforts are being made to locate the parents as soon as possible.

Signature: ___________________________________________________________________ Date: ___/___/_____

Relationship to Child: __________________________________________________________