Belvidere Park Explorers Registration Form

WAUKEGAN PARK DISTRICT All forms Checked__________ Manager Reviewing ______ 2019 Summer Day Camp Registration Form Special needs reviewed _______Date of Final Review_____ Belvidere Park Explorers Camp (6 -11 years) Medications reviewed________ *Must have... More

WAUKEGAN PARK DISTRICT All forms Checked__________ Manager Reviewing ______ 2019 Summer Day Camp Registration Form Special needs reviewed _______Date of Final Review_____ Belvidere Park Explorers Camp (6 -11 years) Medications reviewed________ *Must have completed 1st grade Final Payments made (Initial next to section) _________ Camper Information Camper’s Name: Home Phone: Address: City: State: ZIP: Child’s Birth Date: _______/_______/_______ Child’s Age: _______ Sex: _______M _______F Parent/Guardian Information #1 Parent/Guardian Information #2  Ms.  Mr.  Ms.  Mr. First & Last Name: First & Last Name: Home Address: Home Address: City, State, Zip: City, State, Zip: Home Phone: Work Phone: Home Phone: Work Phone: Email Address for Confirmation: Email Address for Confirmation: Emergency Contact Name: ________________________________________________ Emergency Contact Phone #: In an emergency situation, every effort will be made to reach a parent first. The __________________________ Less