LaunchTrack

Regular Rate 365.00 + 5% = - $383.25

Method of Payment:

KIDS CAMPER'S INFORMATION:

First name:

Last name:

Camper's Legal Name:

Grade September 2024:

Age (as of July 3rd):

Birthdate (MM-DD-YYY):

At birth my physical/biological sex was:

T-Shirt Size:

Current Home Church:

Returning Camper?:

We do our best to place campers with at least one friend. Please enter requests here (multiple names on a line will not be accepted)

Cabin Mate 1:

Cabin Mate 2:

PARENT/GUARDIAN INFORMATION

Parent/Guardian Name:

Parent/Guardian Cell Number:

Home Phone Number:

Email:

Address:

Address2:

City:

Province / State:

Postal / Zip Code:

MEDICAL INFORMATION

Emergency Contact Name:

Emergency Contact Phone Number:

Emergency Contact Relation to Camper?:

Care Card Number:

Doctor's Name:

Doctor's Phone Number:

Medical Concerns - Explain:

Medications?:

List Medications and Dosage:

Allergies?:

List Allergies:

Does your camper require an Educational Assistant while at school?:

Does your child/youth have any mental, emotional or behavioral designations or conditions (such as anxiety disorders, ADHD etc.) that we should know about?:

If yes, please describe the condition and type of support needed:

SPONSORSHIP

If you are wishing to be sponsored, you will need to reach out to your church to receive a promo code, which will be used on the next payment page. This will be the only way for you to complete this registration form. *choose credit card as payment option, NOT check*