Camp Guadalupe Registration Form

Camp Location

How did you hear about Camp this year?

Family Information

Parent #1

First NameLast Name

Cell Number

Area CodePhone Number

E-mail

Parent #2

First NameLast Name

Cell Number

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Area CodePhone Number

Camper #1

Child #1

First NameLast Name

Birth Date

MonthDayYear

Group (age as of 6/1/2019)

Please choose T-shirt size for the camper

Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is the camper prescribed an inhaler or epi-pen? If yes, please explain any instructions.

If you are finished entering all campers, scroll to the bottom of the page.

Camper #2

Child #2

First NameLast Name

Birth Date

MonthDayYear

Group (age as of 6/1/2019)

Please choose T-shirt size for the camper

Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is the camper prescribed an inhaler or epi-pen? If yes, please explain any instructions.

If you are finished entering all campers, scroll to the bottom of the page.

Camper #3

Child #3

First NameLast Name

Birth Date

MonthDayYear

Group (age as of 6/1/2019)

Please choose T-shirt size for the camper

Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is the camper prescribed an inhaler or epi-pen? If yes, please explain any instructions.

If you are finished entering all campers, scroll to the bottom of the page.

Camper #4

Child #4

First NameLast Name

Birth Date

MonthDayYear

Group (age as of 6/1/2019)

Please choose T-shirt size for the camper

Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is the camper prescribed an inhaler or epi-pen? If yes, please explain any instructions.

If you are finished entering all campers, scroll to the bottom of the page.

Camper #5

Child #5

First NameLast Name

Birth Date

MonthDayYear

Group (age as of 6/1/2019)

Please choose T-shirt size for the camper

Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is the camper prescribed an inhaler or epi-pen? If yes, please explain any instructions.

Camp Guadalupe 2019 Camper Registration

Camper #2

Camper #3

Camper #4

Camper #5