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PUGET SOUND WILDCARE RAPTOR CAMP 2021 REGISTRATION
All camps are $250.00 for the week: One form per individual camper.
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Camper's Name
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Your answer
Date of Birth
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MM
/
DD
/
YYYY
Age
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Your answer
Grade
Your answer
REGISTRATION FOR (check one or more, $250.00 for each week)
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July 12 - 16, 2021
July 26 - 30, 2021
August 9 - 13, 2021
August 23 - 27, 2021
Required
Parent / Guardian Name:
*
Your answer
Address:
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Your answer
City:
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Your answer
State:
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Your answer
Zip:
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Your answer
Cell #:
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Your answer
Alternate Phone #:
Your answer
Emergency Contact Name:
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Your answer
Emergency Contact Relationship:
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Your answer
Emergency Contact Cell #:
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Your answer
Emergency Contact Alternate #:
Your answer
Students must be signed in/out daily by drivers license as ID form. List any adults authorized to sign student in/out of camp including name, relationship, and phone #.
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Your answer
Is your student allergic to any medications and/or foods?
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Yes
No
Required
If yes, please list:
Your answer
Does your student require any special accommodations? If yes, please describe:
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Your answer
I understand that and agree to abide by the information here and that I and my student will abide by the safety rules of Puget Sound WildCare Raptor Camp. My signature also authorizes permission for my child to be treated with emergency and medical services if needed and authorizes emergency contact list above to pick up my child from the program and make decisions regarding my student if I am not available. I understand that every effort will be made to contact me if such emergency arises.
*
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No
Signature:
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