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| Camper Name | Camper Birthday | Camp Registering For | School Grade entering Fall 2021 | What organization are you signing up with? | Who does the camper live with? | Scholarship | Mother Name | Mother Address | Mother Email | Mother Cell Phone | Mother Work Phone | Employer Name | Employer Phone # | Employer Address | Father Name | Father Address | Father Email | Father Cell Phone | Father Work Phone | Employer Name | Employer Phone # | Employer Address | Guardian Name | Guardian Relationship | Guardian Address | Guardian Email | Guardian Cell Phone | Guardian Work Phone | Employer Name | Employer Phone # | Employer Address | Alternate Emergency Contact Information | Name | Relationship | Cell Phone | Work Phone | Address | Pick Up Authorization Information (if different from parent or guardian): | Name | Phone | Address | Name | Phone | Address | I agree to this Minor License Agreement and Release | Is Camp Trident allowed to administer sunscreen to your child in accordance with camp standard procedure? | If you have specific instructions for applying sunscreen, please write here. | Is your child allowed to participate in special trips or excursions away from the main camp? | Are there any activities you do not want your child to partcipate in? If so, please list below: | Child's Doctor | Doctor's Phone | Allergies | Date of Child's Last Tetanus Shot | Childs Outstanding Medical History (i.e., Diabetes, Heart Diseases, etc.): | Current Medications | Insurance | Insurance Company | Policy Number | Subscriber's Name | Subscriber's Place of Employment | I agree to the authorize emergency medical treatment for my child | How do you plan on traveling to camp? | Explanation for 'Other or Unsure' | Flight Information | Name of Person Responsible for Payment | Billing Address | Payment (Virginia or West Virginia) | Payment (Colorado) | Billing Email (For Receipt) | Payment Amount | Payment Date |
| Camper Name | Camper Birthday | Camp Registering For | School Grade entering Fall 2021 | What organization are you signing up with? | Who does the camper live with? | Scholarship | Mother Name | Mother Address | Mother Email | Mother Cell Phone | Mother Work Phone | Employer Name | Employer Phone # | Employer Address | Father Name | Father Address | Father Email | Father Cell Phone | Father Work Phone | Employer Name | Employer Phone # | Employer Address | Guardian Name | Guardian Relationship | Guardian Address | Guardian Email | Guardian Cell Phone | Guardian Work Phone | Employer Name | Employer Phone # | Employer Address | Alternate Emergency Contact Information | Name | Relationship | Cell Phone | Work Phone | Address | Pick Up Authorization Information (if different from parent or guardian): | Name | Phone | Address | Name | Phone | Address | I agree to this Minor License Agreement and Release | Is Camp Trident allowed to administer sunscreen to your child in accordance with camp standard procedure? | If you have specific instructions for applying sunscreen, please write here. | Is your child allowed to participate in special trips or excursions away from the main camp? | Are there any activities you do not want your child to partcipate in? If so, please list below: | Child's Doctor | Doctor's Phone | Allergies | Date of Child's Last Tetanus Shot | Childs Outstanding Medical History (i.e., Diabetes, Heart Diseases, etc.): | Current Medications | Insurance | Insurance Company | Policy Number | Subscriber's Name | Subscriber's Place of Employment | I agree to the authorize emergency medical treatment for my child | How do you plan on traveling to camp? | Explanation for 'Other or Unsure' | Flight Information | Name of Person Responsible for Payment | Billing Address | Payment (Virginia or West Virginia) | Payment (Colorado) | Billing Email (For Receipt) | Payment Amount | Payment Date |
