Event Name:

Name:

Age:

(Check appropriate camp choice)

Basketball

Cheerleading

Address:

City:

Home Phone:  

Cell Phone:

Home email Address:

Date of Birth:  

Last School Year Completed:

Emergency Contact:

Mother (Name & Number):

Father (Name & Number):  

Other (Name & Number):   

Allergies/Medical Conditions:

Home Church:

Name of special friend your child might like to be with: