Camper's Full Name First Name * Middle Name Last Name * Gender Male Female Birth Date * e.g. MM/DD/YYYY Home Address * Home Phone or Cell Phone Number * Parents Father's Full Name * Father's Address * Father's Cellular Phone * Mother's Full Name * Mother's Address * Mother's Cellular Phone * Parent/Legal Guardian's preferred email address * Health Information (Please Print) Any known allergies or allergic reactions? Does your child carry an Epi-Pen, wear a medical bracelet/necklace or need special medications? If yes, please detail here: Any chronic illness/medical conditions that we should be aware of? Health Card # * Healthcare Provider (Doctor) Name and Telephone Number: List an additional emergency contact name & cell phone number: * × 2 = eighteen If you are human, leave this field blank.