CAMPER INFORMATION
CAMPER
Name: _________________________________________________________ Age:_________________
Address:__________________________________________________ Phone: _____________________
Sex: ____M _____F Date of Birth: _____/_____/____ School Grade next term: ______________
If the camper has any special talents, please list (e.g. certified lifeguard): _________________________
Camp Session Registered for: _____________________________ T-shirt Size: __________________
If returning camper, what resource field(s) did you study: ______________________________________
PARENT/GUARDIAN
Name: _______________________________________________________________________________
Address: ________________________________________________ Home Phone: _______________
Relationship to Camper: ____________________________________ Work Phone: ________________
Email: __________________________________________________ Cell Phone: _________________
Employer Information: Mother/Guardian: ______________________ Phone: ____________________
Father/Guardian: ______________________ Phone: ____________________
If neither parent/guardian can be located in case of an emergency, please call:
Name: ___________________________________________ Phone: _____________________
Relationship to Camper: __________________________________________________________
CAMPER’S PERSONAL PHYSICIAN
Name: ___________________________________________ Phone: ____________________
Address: _____________________________________________________________________
TRANSPORTATION – Person(s) authorized to transport camper to/from camp if different from parent or guardian
Name: ___________________________________________ Phone: ____________________
Address: _____________________________________________________________________
PARENTAL AUTHORIZATIONS
Emergency Treatment: In case of emergency, I understand that every effort will be made to contact one of the emergency contacts listed on this Camper Information document. If it is not possible to locate any of these emergency contacts, I hereby give permission to camp officials to call a doctor or emergency medical service to assist and for said doctor or medical service to provide emergency medical or surgical care for this child.
Participation: I hereby give permission for this child to participate in all camp activities, including outings or excursions where campers will be hiking or riding in a vehicle away from camp premises, with the following exceptions:
Pictures: Permission is hereby given for Camp Rocky and the Rocky Mountain Mennonite Camp to use any pictures in which my child appears for publicity purposes.
Signature: ____________________________________________________ Date: _____/_____/________
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