Camp Application Form
Parent Information
Parent's Name
First
Last
Email
Enter Email
Confirm Email
Phone
Children Attending
Date of Camp applying for
MM slash DD slash YYYY
Child's Name
Allergies/Medications
Age
Date of Birth
MM slash DD slash YYYY
T-shirt Size
Child's Name
Allergies/Medications
Age
Date of Birth
MM slash DD slash YYYY
T-shirt Size
Child's Name
Allergies/Medications
Date of Birth
MM slash DD slash YYYY
Age
T-shirt Size
Adults Allowed To Pick Up Children
Name
Phone Number
Name
Phone Number
Consent
I Agree to the Following Policies
I understand that it is my responsibility to sign my child in when I drop them off in the morning. Furthermore I understand that it is my responsibility to sign them out before leaving in the afternoon. Sign-in/Sign-out sheets are available as you arrive at the program area.
I understand that my child will not be allowed to leave the program with an unauthorized person. . Any person authorized to pick up my child must be listed on this form. Authorizatoin by telephone will not be accepted.
I authorize VERDURE staff/personal to administer or seek medical services as appropriate in the event of injury of illness.
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Phone
This field is for validation purposes and should be left unchanged.
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