Registration 2023 Summer Camp Registration Form Participant's Information: Age D.O.B Gender: Male Female School Name: Height: Weight: Eye Color: Brown Hazel Blue Green Gray Amber Black Parent's Information: Parent's Information: Email Home Address: City: State: Zip: Phone Number: Alternate Number: Who is Guardian? Mother Father Grandparents Guardian Both Parents Emergency Contact/Authorized Pick-Up: Relationship to child Phone Number Emergency Medical Information Asthma Diabetes Fainting Spells Convulsion Emergency Medical Information Contact Lens Heart Trouble High Blood Pressure Other Other Please attach your child's Immunization records Waiver Agreement By accepting and checking off this box I hereby authorize Community Lifestyle and give my consent to all above. Submit
