Summer Camp | My Site

Parent Information

Parent/Guardian First Name

Parent/Guardian Last Name

Phone Number

Additional Parent/Guardian First Name

Additional Parent/Guardian Last Name

Phone Number

Camper Information

Participant First name

Participant Last name

Date of Birth

Address

Medical Information

Physician Name

Physician Phone Number

Food Allergies

Food Allergy/Allergies

Medication(s) Prescribed

Special Instructions

Natural/Seasonal Allergies

Nature/Season Allergy/Allergies

Medication(s) Prescribed

Special Instructions

Other Allergies

Other Allergy/Allergies

Medication(s) Prescribed

Special Instructions

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Registration Fee - $50

Thanks for registering for the Building The Next Legacy 2024 Summer Camp! Let the fun begin!