%S

Child Name

Registered child name only

First Name

Last Name

E-mail

Camp information

Guardian Name

Age

Date of Birth

Address

City, Fl

Zip Code

T-Shirt Size

Home/Cell Phone

Emergency Contact

A family memeber

Allergies

If any medical reactions please list

Child's Favorite Color

Important

Medication List

List all medication below

Have your child ever been bullied?

Yes- Option 1 No- Option 2

Summer Camp Fee Per-child Per-week

I KNOW MY WORTH SUMMER CAMP

I KNOW MY WORTH SUMMER CAMP

I KNOW MY WORTH SUMMER CAMP

$150.00