WAUKEGAN PARK DISTRICT 2019 Summer Day Camp Registration Form All forms Checked__________ Manager Reviewing ______ Lilac Cottage Destination Exploration Camp (5 -10 years) Special needs reviewed _______Date of Final Review_____ Medications reviewed________...
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WAUKEGAN PARK DISTRICT 2019 Summer Day Camp Registration Form All forms Checked__________ Manager Reviewing ______ Lilac Cottage Destination Exploration Camp (5 -10 years) Special needs reviewed _______Date of Final Review_____ Medications reviewed________ *Must have completed Kindergarten 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 ______________
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