Day Camp Registration Day Camps (select all of interest) * June 5-9 Crosby Farm June 26-30 Crosby Farm July 3-7 Theodore Wirth July 10-14 Theodore Wirth July 24-28 Crosby Farm July 31-August 4 Crosby Farm August 7-11 Theodore Wirth August 21-25 Theodore Wirth Child's Name * If you are registering for 2 children or more, please register twice but ignore repeated answers First Name Last Name Current preferred Gender identity * Age during Camp * Name of Parent * First Name Last Name Parent cell phone (###) ### #### Name of other parent/guardian First Name Last Name Their cell phone number (###) ### #### Email Address Address 1 Address 2 City State/Province Zip/Postal Code Country Please describe your child's health * Bee sting allergies * Yes No Unsure Dietary/other restrictions/allergies and degree of severity, reactions etc * I respectfully request your consent to use participant photographs on my website * Yes No Alternative Emergency Contact Information: Name, Relation, Address & Phone Please describe your child. Consider their personality traits, their strengths, and their challenges. What you like me to know about this young person to help them have the best experience possible? * Thank you!
