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Please complete the following form, and when complete “click” or “tap” the submit button on the bottom of the page. Please be a little patient – it takes some time for the website to format the information and write it to the on-line database. After your information has been recorded, you will be taken to a new page which will provide you with information the ‘next steps.’
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Camper's Information
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Campers Name:
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First
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Last
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Campers Birth Day
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Month
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Day
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Year
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Age
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School Attending in Fall
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Grade in Fall
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Gender
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Shirt Size
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Mother’s Information
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Mothers Name
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Cell Phone
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No Spaces - Example (480)123-4567
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Work Phone
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No Spaces - Example (480)123-4567
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Father’s Information
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Fathers Name
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Cell Phone
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No Spaces - Example (480)123-4567
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Work Phone
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No Spaces - Example (480)123-4567
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Contact Information
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Street Address
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City
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Zip
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Primary E-Mail Address
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Second E-Mail Address (optional)
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Home Phone Number
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Example (480)123-4567
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Allergies and Medications
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Please Note - There is NO nurse on Campus; therefore we may not administer any medication
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Allergies - if none, please indicate None
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Medications - if none, please indicate None
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Emergency & Doctor’s Information
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In the event that we cannot reach you, please provide the names of two people that we can contact in case of an emergency or sickness:
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Emergency Contact #1
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Name
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Phone 1
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No Spaces - Example (480)123-4567
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Phone 2
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No Spaces - Example (480)123-4567
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Emergency Contact #2
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Name
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Phone 1
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No Spaces - Example (480)123-4567
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Phone 2
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No Spaces - Example (480)123-4567
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Doctor’s Name:
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Phone Number
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No Spaces - Example 480-123-4567
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Permissions
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My child has my permission to be photographed for camp publicity, i.e. campus fairs, campus newspaper, and local newspapers, camp web site and magazines.
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In the event that I cannot be reached in an emergency, I Here by give permission for Imagine That! Summer Camp staff to secure medical treatment for my child.
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Camp Selections
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Session I Camps June 3rd through June 20th
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Jump Start
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Morning Session:
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Friend Request
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Choice 1
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Choice 2
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Afternoon Session:
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Friend Request
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Lunch Bunch
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Choice 1
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Choice 2
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Gymnastics
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Session II Camps June 24th through July 5th
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Morning Session
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Jump Start
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Friend Request
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Choice 1
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Choice 2
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Afternoon Session
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Lunch Bunch
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Friend Request
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Choice 1
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Choice 2
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Gymnastics
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Again, please be a little patient – it takes some time for the website to format the information and write it to the on the database.
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