What camps are your children registered for? *

Please check all that apply.

Woodland and Seashore Adventure, Session I, June 17-21

Woodland and Seashore Adventure, Session II, June 24-28

Doll Camp, July 1-3

Little House on the Prairie Camp, Session I, July 8-12

Wildcraft Craft Camp, July 15-19

Fairy Gnome Camp, July 22-26

Spanish Camp, July 29-August 2

Little House on the Prairie Camp, Session II, August 5-9

The Hero's Guild, August 12-16

Child's Name *

We need the information on this form for each camper, so for multiple children in the same family, please make use of the additional name and date fields. Thanks!

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Child's Name

First Name

Last Name

Date of Birth

MM

DD

YYYY

Child's Name

First Name

Last Name

Date of Birth

MM

DD

YYYY

Parent/Guardian Name *

First Name

Last Name

2nd Parent/Guardian Name (optional)

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Daytime Phone *

(###)

###

####

Secondary Phone (Emergency, etc)

(###)

###

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Emergency Contact Name (other than parent/guardians) *

First Name

Last Name

Emergency Contact Daytime Phone *

(###)

###

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Doctor's Name *

First Name

Last Name

Doctor's Phone *

(###)

###

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Dentist's Name *

First Name

Last Name

Dentist's Phone *

(###)

###

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