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Summer Safari Registration Form
This form is to be completed by the child's parent or legal guardian.
Please complete this form for EACH participating child each date.
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* Indicates required question
Email
*
Your email
Order ID Number
*
Located on the order receipt email
Your answer
Camp Date
*
MM
/
DD
/
YYYY
Camp Type
*
Junior Summer Safari (ages 6-9)
Senior Summer Safari (ages 10-13)
Camper's First Name
*
Your answer
Camper's Last Name
*
Your answer
Camper's Preferred Name
*
Preferred first name to be displayed on name tag
Your answer
Camper's Date of Birth
*
MM
/
DD
/
YYYY
Camper's Sex
*
Male (M) or Female (F)
M
F
Camper's Full Address
*
Including city, state, and zip code
Your answer
Parent or Guardian's First and Last Name
*
Your answer
Parent or Guardian's Phone Number
*
No dashes or hyphens
Your answer
Parent or Guardian's Email Address
*
Your answer
Medical Information
*
Does the camper have any of the following?
Special diet
Allergies
Medication
Chronic/recurring illness
Surgery or serious illness in last year
Physical conditions that limit activity
None of the above
Other:
Required
If you selected any of the above, please explain:
Your answer
I declare the above information is accurate.
*
Yes
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