August Camp

First Name *
Last Name *
Cell Phone *
Email *
Grade (as of 2018) *
Birth Date *
Address *
City *
State *
Zip Code *
Medical Information *

Please list any applicable medical conditions or medications. Enter N/A if none

Page 1 of 2

Next >>

Guardian First Name *
Guardian Last Name *
Guardian Cell Phone *
Guardian Email *
(Optional) Guardian First Name
(Optional) Guardian Last Name
(Optional) Guardian Phone
(Optional) Guardian Email
Medical Release Information

Guardian Signature *

By typing your name in the signature box and clicking submit, you agree that you are electronically signing this agreement in accordance with the Electronic Signatures Act (Public Law No: 106-229), and agree to be bound by all terms and conditions.: clear

Page 2 of 2

<< Previous

$10.00

Qty:

STUDENT INFORMATION