Summer Camp Application - Springwood School

Student Name: *

Family Name: *

English Nickname: *

Address: *

City: *

Zip Code: *

Country: *

Gender: *

Date of Birth: *

Age: *

Current Grade in School: *

How did you hear about this camp? *

Do you work with an agency? *

Name of Agency: *

Shirt Size:

Consent for the child's photograph to be released? *

Does your child have any allergies to food or medicine? *

Please name foods or medicines to be avoided: *

Does your child have any medical conditions we need to be aware of? *

Please name any conditions we need to be aware of: *

Will your child have medicine, inhaler or epi-pen on site? *

Please list medicines your child will bring: *

Guardian First Name: *

Guardian Last Name: *

Relationship: *

Phone: *

Email: *

Additional Guardian First Name:

Additional Guardian Last Name:

Relationship:

Phone:

Email:

Enter Your Email Address: *