2019 Camp Registration Form

1Child Information

2Child Medical Details

3Guardian Information

4Camp Tuition

Guardian #1 (Father)
Father’s Name*
First Last
- Check here if father's home address & home phone is same as child’s
Address*
Street Address Address Line 2 City State ZIP Code
Home Phone Number*
Cell Phone Number*
Work Phone Number*
Email Address*
Guardian #2 (Mother)
Mother’s Name*
First Last
- Check here if mother's home address & home phone is same as child’s
Address*
Street Address Address Line 2 City State ZIP Code
Home Phone Number*
Cell Phone Number*
Work Phone Number*
Email Address*
List names of authorized person(s) to pick up child from camp other than Guardian(s)? (Click plus sign below to add more than one name.)
First Name Last Name

This field is optional if you do not want anyone other than the Guardian(s) to be permitted to pickup the child. Please note you may click the Plus sign above to add additional rows for more names.

Register Now for Go Camp Logos Summer Day Camp!

First Name	Last Name