2021 Real Life Day Camp Registration Form

Camper Information

You will notice that our online registration form has been updated! You will now be asked to input additional information that, in previous years, was hand-written onto the Child Infomation Card. At the end of registration process, you will be able to print out both your Registration Form and your Child Information Card.
Please mail both in with the check for the total deposit.
Days Coming -> Camper Information -> Parent Information -> Additional Information -> FINISH

/ /    () -    
*Email address:
                            *This is where your confirmation email and reciepts will be sent.
Name of Child's Physician or Health Clinic: Physician's Phone Number:
() -
Address of Child's Physician or Health Clinic: City:
State:   Zip:
Hospital Preferred for Emergency Treatment: Name of Insurance Carrier:
Date of Last Tetanus Shot: Health Insurance Policy Number:
Allergies, if any:
(Type out the word, not the number):
six plus three =