Child #1 Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Acknowledgement of Terms *

I ACKNOWLEDGE that a completed Consent for Emergency Medical Treatment (LIC627) for the child(ren) listed above must be filed with Monica Ros before the start of camp.

I ACKNOWLEDGE that a completed Emergency Contact Form (LIC700) for the child(ren) listed above must be filed with Monica Ros before the start of camp.