Kids Camp Information Form

Please complete the following form prior to the start of your child’s first day of kids camp.

Name

First Name

Last Name

Climber Birthdate

MM

DD

YYYY

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone Number

(###)

###

####

Backup Contact Phone Number

(###)

###

####

Medical Information

Does your child have any medical conditions that may require adaptation? (examples include asthma, heart conditions, injuries, etc.). If yes, please describe.

Allergies

Does your child have any known allergies? If yes, please list allergens and possible reactions.

Authorized For Pick-Up

Please list the people who are allowed to pick up your child after camps

Other Information

Is there any additional information you feel we need to know about your child prior to starting camp?