2023 SUMMER CAMP
REGISTRATION FORM
JULY 10-14, 2023

STUDENT CONTACT INFORMATION

Student's Family Name^*

Name^*

Address^*

City^*

Prov

Postal Code

Phone (home)

Date of Birth

Age

Medical condition (if any):

Allergies (if any):

Medical Health Number:

PARENT CONTACT INFORMATION

Father's First/Last Name

Mother's First/Last Name

Father's cell

Mother's cell

Father's email

Mother's email

EMERGENCY CONTACT INFORMATION

Contact 1: First and Last Name

Cell

Contact 2: First and Last Name

Cell

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