High School Summer Camp

Participant Contact Information

Name

Phone Number

Address

City, State and ZIP Code

School

Grade

Registration Fee

Help Another Kid Go By Donating to Scholarship Fund

Running Total

$0.00

Total

$0.00

Medical Insurance Company

Medical Insurance Policy Number

Are there any medical situations (allergies, prescriptions, etc) that we need to know about?

Digital Signature of Legal Guardian

Consent and Release Form

I, the undersigned, agree to the terms above.