Parent's Name *

First Name

Last Name

Parent's Phone # *

(###)

###

####

Child's Name *

First Name

Last Name

Child's Date of Birth

MM

DD

YYYY

Consent to have child's picture taken during camp *

Yes, I consent to my child's picture being taken

I do not consent to my child's picture being taken

Drop-In Date *

MM

DD

YYYY

Start Time *

Hour

Minute

Second

AM PM

End Time *

Hour

Minute

Second

AM PM