`Camp Firelight Student Registration Form

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`Camp Firelight Student Registration Form

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* Indicates required question

Student's Name *

Your answer

Parent/Family/Guardian Name *

Your answer

Email Address *

Your answer

Phone Number *

Your answer

Student's Date of Birth *

MM

/

DD

/

YYYY

Student's Age *

Your answer

Special Needs/Allergies/Medical Information that we should be aware of?

Your answer

Emergency Contact (Name and Phone Number) *

Your answer

Photo Release: Do you give permission for your child's photo to potentially be on our website and/or social media? *

Yes

No

Parent/Guardians E-Signature *

Your answer

Submit

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