Family Camp Children's Program Registration

As part of Camp Mishewah's protection plan, we are required to have an accurate record of each person participating in the children's and youth programming. Thank you for your assistance.

Week(s) Attending Family Camp Programs:(Required)

Week 1 (June 27-July 4)

Week 2 (July 4-11)

Week 3 (July 11-18)

Week 4 (July 18-25)

Parent/Guardian 1 Name(Required)

First Last

Parent/Guardian 1 Phone(Required)

Parent/Guardian 2 Name (If Applicable)

First Last

Parent/Guardian 2 Phone

Child Information

Name of Child(Required)

First Last

Sex(Required)

Birthdate(Required)

Age(Required)

Please enter a number from 0 to 17.

Grade Entering In September(Required)

Does your child have any food allergies/intolerances?(Required)

If yes, please describe

Does your child have any life-threatening allergies?(Required)

If yes, please describe

Are there any special needs, instructions or considerations for this child (physical, medical, mental, emotional, social, behavioral concerns or learning disabilities)?(Required)

If yes, please describe

Please remember that you will need to pick up your children after the program. They may not leave on their own for safety reasons.

Consent & e-Signature

Parent/Guardian Name(Required)

First Last

Date(Required)

Thank you for filling in this information so we can better care for your children.