Last Name

First Name

Grade K 1 2 3 4 5 6 7 8 Gender M F

Parents' Names

Home Phone Number (numbers only)

Dad Cell Phone Number (numbers only)

Mom Cell Phone Number (numbers only)

Dad Work Phone Number (numbers only)

Mom Work Phone Number (numbers only)

Camp Sports

Street Address

City State Zip

Age Date of Birth January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Emergency Contact

Phone Number

Relationship to Child

Verification Number