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I Love Being A Girl Summer Camp Registration Form

Ages 7-16 | Limited to 25 Girls

Child's Information

Date of Birth:
Month
Day
Year
T-Shirt Size (Choose One):
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
Adult 2X-L
Adult 3X-L
Adult 4X-L
Adult 5X-L

Parent / Guardian Information

Emergency Contact (If Different from Parent / Guardian)

Medical Information

Does the participant have any known allergies?
Yes
No

If yes, specify type and details:

Severity of reactions:
Mild (rash, itching)
Moderate (swelling, hives)
Severe / Life - threatening (anaphylaxis)
Emergency Medication carried:
Yes
No

If yes, please specify:

Emergency Medication carried:
EpiPen / Epinephrine Auto-Injector
Antihistamies
Other:

Dietary Restrictions:

Multi choice
I authorize camp staff to seek medical attention on behalf of the participant if a severe allergic reaction occurs.
Yes
No

Health Care Provider Information

Health Insurance Information

Is your child covered by insurance?
Yes
No

This information is confidential and will only be used in case of illness or medical emergency during camp.

Pickup Authorization

Valid ID will be required at pickup.

Camp Agreement & Consent

Please initial each:

I give permission for my child to participate in the I Love Being A Girl Summer Camp.

I understand this is a faith-based program that includes biblical teaching and activities.

I give permission for my child to recieve snacks and meals provided.

I understand that photos / videos may be taken for program and promotional use.

I agree to follow all camp policies, including drop-off and pickup times.

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Date
Month
Day
Year

For Office Use Only

Date Registered:
Month
Day
Year
Accepted:
Yes
No
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