Stony Glen Summer Camp Sign-Up

Please fill out ot the information below. You signature on the consent line serves as your actual signature.

Campers First, Last Name	*
Address	*
City, State, Zip	*
Email	*
Paraent/Guardian	*
Phone 1 & 2 (cell)	*

Camp Type (Pee Wee or Reg. ) & Date

Campers Height, Weisght & DOB	*
School	*
Grade	*
Does your child have any special needs that we need to be made aware of?	*

Does your child need any special flotation devices to swim? ie, Life vest, floaties, etc.	*
Dr.s Name and phone number	*
Does your child take any medications?	*
In case of an emency contact: Name, address, Phone 1 & 2	*
Does Stony Glen Camp Counselor have permission to give your child	*	Tylenol Advil Aspirin Does your child have allergies
Does your child have any learning disabilities or other medical conditions that we need to be aware of?	*

Parent's Driver's License Number#	*
Please provide Insurance Information	*

In case of emergency, I hereby give Julie Holmquest or an agent of Stony Glen Stables authority to treat my child.	*