Summer Camp - Camper Information Form

Please complete the form below so that we have all the necessary information about your child attending the camp.

Phone: (904) 866-9901.

Child and Parent Information
Child Name: *
Child's Age:
Child's Grade:
Parent Name: *
Parent Email: *
Phone: *
Select Camp Dates: *
If attending single day camps, please specify date:

Emergency Contact Information

Please provide atleast 1 emergency contact that we can reach in case of any emergencies.
Emergency Contact1 Name: *
Emergency Contact1 Cell Phone: *
Emergency Contact2 Name:
Emergency Contact2 Cell Phone:

Medical Information

Medical information is needed only for medical emergencies.
Insurance Provider Name: *
Insurance ID Number: *
Primary Care Physician Name: *
Primary Care Physician Phone: *
Comments: