Summer Day Camp Registration

For seven weeks after the school year ends, Summer Day Camp gives our youngest members a place to go to have fun and grow in a nurturing environment. Members ages 7 to 12 participate in our camp Monday through Friday from 9:00 am to 5:30 pm.

Primary Information

Child's First Name

M.I.

Last Name

Address

Apt

Phone

City

State

Zip

Date of Birth

Age

Gender
MaleFemale

Emergency Contacts

Name

Relationship

Phone

Name

Relationship

Phone

Parent(s)/Guardian(s)

Mother/Guardian First Name:

Last Name

Work Phone

Cell Phone

Father/Guardian First Name:

Last Name

Work Phone

Cell Phone

Escort Information

I, [parent] (name of parent), authorize my child, [child], to travel UNESCORTED FROM The Brotherhood/Sister Sol Summer Day Camp to home.

Name

Relationship

Phone

Name

Relationship

Phone

Name

Relationship

Phone

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above statement.

Health Information

Child’s Health Problems (please be specific)

Does your child have any special needs?

Does your child have any Dietary Restrictions?

NoYes

Does your child have asthma?

NoYes

Does your child have any allergies?

NoYes

Emergency Information

In case of any emergency, I give my consent for The Brotherhood/Sister Sol to obtain emergency medical treatment for my child.

My Insurance

ID

My Medicaid #

Signature

I, (parent), give permission for my child to participate in The Brotherhood/Sister Sol Summer Day Camp. I release The Brotherhood/Sister Sol from any liability for any injuries my child may incur while engaging in any of the Summer Day Camp activities or trips.

Programs » Summer Leadership Program » Summer Day Camp » Summer Day Camp Registration

Summer Day Camp Registration

Primary Information

Emergency Contacts

Parent(s)/Guardian(s)

Escort Information

Health Information

Emergency Information

Additional Information

Signature