JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Camp Re-Connection
This is our registration form for Camp Re-Connection, and please be aware that we'll need signatures on initial arrival at the camp!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Participant Name
*
Your answer
Participant Date of Birth
*
MM
/
DD
/
YYYY
Participant Gender and Pronouns
*
Your answer
Participant Ethnicity
*
Your answer
Participant Address
*
Your answer
Participant Age and Grade
*
Your answer
Parent/Guardian Name
*
Your answer
Parent/Guardian Address
*
Your answer
Parent/Guardian Cell Number
*
Your answer
Parent/Guardian Email
*
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Relation
*
Mother
Father
Grandparent
Aunt
Uncle
Sibling
Other:
Emergency Contact Phone Number
*
Your answer
Emergency Contact Cell Number
*
Your answer
Does this participant have any allergies, chronic illness, or medical conditions? If yes, please describe:
Your answer
Is the participant prescribed an inhaler/medication(s)? If yes, please explain:
Your answer
The Camper Will Pay Via:
*
Cash or Check (in-person)
Electronically (
https://www.paypal.com/donate/?hosted_button_id=W9J88JLNLJ722
)
Scholarship (email
jsummers@umich.edu
)
Other:
Would you like the participant to have a free Sports Physical?
Yes
No
I'll decide in person (form will be shared)
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of ECI.
Report Abuse
Forms
