JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Town Rec Camper's Information
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Camper's Name (First and Last)
*
Your answer
Gender
*
Female
Male
Camper's Date of Birth
*
MM
/
DD
/
YYYY
Campers Age
*
Your answer
What is the grade the camper will be entering?
*
K
1
2
3
4
5
6
Address
*
Your answer
Town
*
Smithfield
Greenville
Zip Code
*
02917
02828
Parent/Guardian 1 (First and Last Name)
*
Your answer
Parent/Guardian 1 - Email
*
Your answer
Parent/Guardian 1 Cell Phone
*
Your answer
Parent/Guardian 1 Work Phone
Your answer
Parent/Guardian 2 (First and Last Name)
Your answer
Parent/Guardian 2 - Email
Your answer
Parent/Guardian 2 Cell Phone
Your answer
Parent/Guardian 2 Work Phone
Your answer
Child Resides With
*
Mother
Father
Both
Guardian
Other:
Additional Emergency Contact Name (Will be included on the Approved Pick Up List)
*
Your answer
Emergency Contact Cell Phone
*
Your answer
Emergency Contact Home Phone
Your answer
Emergency Contact Relationship
*
Your answer
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
