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Serene Lakes Science Camp Registration Form
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Email
*
Your email
Participants Name
*
Your answer
Age (at time of camp)
Your answer
Parent Name
*
Your answer
Parent Phone number
*
Your answer
Parent email address
*
Your answer
Home Address (Street, City, State, Zip)
*
Your answer
Alternative Emergency Contact (name and phone number)
*
Your answer
Health Insurance Company and Policy Number
*
Your answer
Please tell us about any medical history or present conditions that may affect participation in a group hike or outdoor learning environment.
*
Your answer
List any medications the participant is taking.
*
Your answer
List the participant’s allergies.
*
Your answer
List all dietary restrictions.
*
Your answer
Use the space below to tell us any other pertinent information about the participant.
Your answer
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