Enter your 4- or 5-digit member #:
Child's Birth Date•
Alternate Emergency Contact
Adults who are authorized to pick up your child from camp in addition to guardian(s)
Does your child have any allergies and/or serious medical conditions? Please describe:
Is your child taking medication that will continue through his/her camp? Please describe:
Please feel free to use this space if there is anything else you would like to share about your child:
Payment Please let us know how you'd like to pay.