Summer Camp 2008 Registration Form

Davis Legacy Summer Camp Online Registration

Personal Information

First Name: *

Last Name: *

Birthday: *

Email Address: *

Required to send confirmation email

Address: *

City: *

Zip Code: *

Father

Father's Name:

Father's Day Phone:

Father's Cell:

Mother

Mother's Name:

Mother's Day Phone:

Mother's Cell:

Emergency Information

Emergency Contact

In an emergency when parent/guardian cannot be reached, please contact the following:

Contact Name: *

Contact Phone: *

Contact Cell:

Relationship: *

Allergies:

Physician

Physician Name:

Physician Phone:

Insurance

Medical/Hospital Insurance Company: *

Insurance Phone: *

Policy Holder's Name: *

Policy Number: *

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