Next Generation Summer Camp 2019
- Please fill out the following
* Social Security Number
* Place of Birth
Allergies / child notes
* Medications taken regularly
* Primary Care Physician
* Primary Care Physician Phone
* Insurance Company
* Insurance Company Policy Number
* Insurance Company Group Number
- Please use someone not living in the same household
* Emergency Contact Name
* Emergency Contact Phone #
- Please list parent or guardian information.
* Parents/Guardian Name
* Parents/Guardian Phone #
* Parent/Guardian Email
* Registration Cost
Early Bird (Jan 1 - Apr 8) ($180.00)
Regular Rate (Apr 8 - May 19) ($230.00)
- Mark your calendars for June to be at our camp parent meeting
- You must read the release statement and enter your name below in the digital signature field to confirm.
* Digital Signature- I HAVE read the release statement linked above.
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