GFWC Sebastian River Junior Woman’s Club

Elementary Summer Science Camp Registration Form

 

Participant Information

 

First Name________________________    Last Name_____________________       Date of Birth ___________

 

Address _________________________________________City, State, Zip ______________________________

 

Home Phone __________________________     Parent/Guardian Email _______________________________

 

Address______________________________

 

Parent/Guardian Cell Phone _______________________________   Current Grade ____________

 

T-Shirt Size:        Youth Small      Youth Medium            Youth Large             Youth XL                                        

(Circle)                                               

     Adult Small          Adult Medium                     Adult Large                Adult XL

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Medical Information

List Health Problems, Behavioral Problems, Allergies, and Special Dietary Needs ____________________________________________________________________________________________________________________________________________________________________________________________________

Daily Medications?  If yes, explain.  ____________________________________________________________________________________________________________________________________________________________________________________________________

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Emergency Contact Information

Parent/Guardian Name ____________________________________________

 

Contact #2 Name _____________________________________Contact #2 Phone ___________________

 

Contact #3 Name _____________________________________Contact #3 Phone________________

 

List ALL People Authorized to Pick Up Child (will be asked to show photo identification)

_____________________________________________________________________________________________________________________________________________________________________________________________

 

 

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science-kids[1]

Please fill in forms completely and return with full payment to:

GFWC Sebastian River Junior Woman’s Club, 952 US 1, Sebastian, FL 32958

 

Make checks payable to GFWC SRJWC

Kid's Science Camp

Registration

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