Camper Application 2018

Camper Name

Birthdate *

Parent/Legal Guardian *

Home Address *

Phone Number *

Cell Phone

Work Number

Emergency Contact *

Emergency Contact Phone *

Unnamed

Has your Child seen/Consulted with a social worker, psychologist and/psychiatrist in the last 6 months? *

Unnamed

Camper Name

Birthdate

Home Address

Phone Number

Emergency Contact

Parent/Legal Guardian

Cell Phone

Unnamed

Has your Child seen/Consulted with a social worker, psychologist and/psychiatrist in the last 6 months?

Work Number

Unnamed

Emergency Contact Phone