Camper Form. Camper Form. Parent/ Guardian Name #1 * First Name Last Name Parent/ Guardian Name #2 First Name Last Name Home Address Address 1 Address 2 City State/Province Zip/Postal Code Country Parent/ Guardian Contact Number #1 (###) ### #### Parent/ Guardian Contact Number #2 (###) ### #### Email Camper's Name #1 First Name Last Name Camper's Name #2 First Name Last Name Camper #1 Entering Grade Level Entering Kinder Entering First Grade Entering Second Grade Entering Third Grade Entering Fourth Grade Entering Fifth Grade Camper #2 Grade Level Entering First Grade Entering Second Grade Entering Third Grade Entering Fourth Grade Entering Fifth Grade Camper #1 Date of Birth MM DD YYYY Camper #2 Date of Birth MM DD YYYY Allergies Health Insurance Provider Health Insurance Policy # Health Insurance Provider Group/Member # Family Physician Name Family Physician Phone # (###) ### #### Alternate Pick Up Name and Number Emergency Contact Name and Number Camp Week Requested: Thank you!
