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* Indicates required information
First child
 
Child's Information
 
Child's name: *
Date of Birth: *
Gender: * Female   Male
Does your child have any medical conditions the staff should be aware of (i.e. allergies)?
Indicate any special medical attention your child may require:
 
Is your child's immunization up to date? * Yes   No
Swimming ability: Does your child require a life jacket in shallow water? * Yes   No
For possible future advertising we need consent from parent to include photographs and video of children * Yes   No
Children must be 48" to ride the waterslides. Do you give permission for your child to ride the waterslides that drop into a pool? * Yes   No
Do you give permission for your child to ride the waterslides that run out and do NOT drop into a pool? * Yes   No
 
Parent's Information
 
Parent name: *
Phone: *
Alternate phone:
 
Camps
  Jul 23
to
Jul 27
Jul 30
to
Aug 3
Aug 7
to
Aug 10
Aug 13
to
Aug 17
Aug 20
to
Aug 24
Aug 27
to
Aug 31
 
Chipper's Day Camp
(Ages 6 - 12)
 
Chipper's Jr. Day Camp
(Ages 4 - 5)
 
MVP Sports Camp  
Chef Camp    
Eco-Explorers Camp  
Paintball Camp    
Camp Couture (Fashion Camp)        
Bowling Camp      
MineCraft Camp    
Arts Camp      
 
 
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Emergency contact information
Contact name(s): * Relationship: * Home phone: * Work phone: