Nonprofit Health & Wellness Camp
Child Registration Form
Child Information
Full Name
Date of Birth
Gender
Male
Female
Other
Prefer not to say
Current Grade
Parent / Guardian Information
Full Name
Relationship to Child
Phone Number
Email
Address
Emergency Contacts
Name
Phone Number
Relationship to Child
Medical Information
Allergies / Medical Conditions
Required Medications
Physician Name
Physician Phone
Health Insurance Information
Permissions & Agreements
I grant permission for my child to be photographed for camp purposes.
I authorize emergency medical treatment for my child.
I certify that the above information is correct and agree to camp policies.