Creative Camp 2017 Multiple Student Registration Form

Student 1 Full Name: *
First Name
Middle
Last Name
Student 1 date of birth:*
Student 1 Age: *
Please choose a shirt size. *
Choose Preferred Activity *
Choose Preferred Activity *
Choose Preferred Activity *
Choose Preferred Activity *
Student 1, please list special needs, allergies or other concerns.
Student 2 Name:
First Name
Middle
Last Name
Student 2 date of birth:
Student 2 Age:
Please choose a shirt size
Choose Preferred Activity
Choose Preferred Activity
Choose Preferred Activity
Choose Preferred Activity
Student 2 Special needs/Allergies/other concerns
Student 3 Full Name:
First Name
Middle
Last Name
Student 3 date of birth:
Student 3 Age:
Please choose a shirt size.
Choose Preferred Activity
Choose Preferred Activity
Choose Preferred Activity
Choose Preferred Activity
Student 3 Special needs/Allergies/other concerns
Student 4 Full Name:
First Name
Middle
Last Name
Student 4 date of birth:
Student 4 Age:
Please choose a shirt size.
Choose Preferred Activity
Choose Preferred Activity
Choose Preferred Activity
Choose Preferred Activity
Student 4 Special needs/Allergies/other concerns
Parent or Guardian Name (This will be considered the Emergency Contact.) *
First Name
Middle
Last Name
Mailing address: *
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Contact phone number:*
Email Address:
Emergency contact (if different from above):
Emergency Contact Number:
Is there a friend your student would like to be with during our activity? Please list the friends name here.