Camper's Full Name* First Name Last Name Camper's Nickname Birth Date* 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Gender* malefemale MEDICAL INFORMATION Allergies* Does camper have any allergies (foods, medications, insects, etc.) If there are allergies, does camper have an epi-pen? yesno Is the camper on any medication?* yesno Medication If the camper is on medication, please list name, dosage, condition being treated and prescribing doctor Please list name and contact information for child's pediatrician* Does the camper have any medical, behavioral, psychological or other issues of which we should be aware?* Does camp staff have permission to help child apply sunscreen?* yesno Please list your medical insurance information* Company, plan, id number; name and birthdate of responsible party CAMP EXPERIENCE Does your child know how to swim?* yes, very wellyes, basic water skillsbeginning to learnno Please tell us about your child's personality, likes and dislikes Does your child have any goals for the summer? Anything else we should know? Submit Should be Empty: This page uses TLS encryption to keep your data secure.