MADRONA SCHOOL SUMMER CAMPER INFORMATIon
June and July, 2018

What camps are your children registered for? *
Please check all that apply.
Child's Name *
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!
Date of Birth *
Date of Birth
Child's Name
Child's Name
Date of Birth
Date of Birth
Child's Name
Child's Name
Date of Birth
Date of Birth
Parent/Guardian Name *
Parent/Guardian Name
2nd Parent/Guardian Name (optional)
2nd Parent/Guardian Name (optional)
Address *
Address
Daytime Phone *
Daytime Phone
Secondary Phone (Emergency, etc)
Secondary Phone (Emergency, etc)
Emergency Contact Name (other than parent/guardians) *
Emergency Contact Name (other than parent/guardians)
Emergency Contact Daytime Phone *
Emergency Contact Daytime Phone
Doctor's Name *
Doctor's Name
Doctor's Phone *
Doctor's Phone
Dentist's Name *
Dentist's Name
Dentist's Phone *
Dentist's Phone