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Camper Registration Form: Week 7: Camp Bumbleburry
Camping Dates: August 6th - 11th - Ages 9 to 15
All camps begin on Sunday at 3pm and end on Friday at 12pm.
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Camper Information
Camper's Last Name
*
Your answer
Camper's First Name
*
Your answer
Camper's Preferred Name
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Gender
*
Male
Female
Address
*
Your answer
Name of school and grade
Your answer
Faith (if applicable - for statistical use only)
Your answer
Doctor's Name
Your answer
Doctor's Phone Number
Your answer
MCP Number
*
Your answer
Legal Custody
*
Both Parents
Mother
Father
Guardian
Required
Cabinmate Request #1
This is not a guarantee that two campers will be in the same room.
Your answer
Cabinmate Request #2
This is not a guarantee that two campers will be in the same room
Your answer
T-Shirt Size - These are adult sizes. Registrations submitted after June 1st are not guaranteed their chosen size.
*
S
M
L
XL
Photo Consent
*
Your child may photographed or videoed at camp. Please indicate if photos or videos of your child may be used for program or promotion of the camp. Each child will be sent home with a camp photo from their week.
Yes - Photos/Videos of my child may be used
No - Photos/Videos of my child may NOT be used
Please indicate and give details in the field below if your child has any special dietary concerns.
Your answer
Other information
Please provide any other information you feel is necessary for the counselors of the camp to be made aware of in the space below.
Your answer
Parent/Guardian #1 Information
Parent/Guardian #1 Name
*
Your answer
Home Phone
*
Your answer
Cell Phone
Your answer
Work Phone
Your answer
Address if different from camper
Your answer
Email Address
*
Email is used for most of our correspondence
Your answer
Parent/Guardian #2 Information
Parent/Guardian #2 Name
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Work Phone
Your answer
Address if different from camper
Your answer
Email Address
Email is used for most of our correspondence
Your answer
Alternate Emergency Contact
Please provide contact information for someone in the event that the Parent/Guardians listed previously are unavailable.
Name
*
Your answer
Contact Number
*
Your answer
Other Phone
Your answer
Relationship to camper
Your answer
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