Name *

First Name

Last Name

Phone *

(###)

###

####

Emergency Contact *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date *

Birthday

MM

DD

YYYY

Release *

I, the undersigned parent/guardian, hereby release the camp organizers, staff, and partners from all liability arising from participation in camp activities, except in cases of gross negligence. I understand that reasonable precautions will be taken to ensure participant safety.

Click to Sign

Pick Up *

Is your child allowed to walk home alone?

Yes

No