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PARTICIPANT REGISTRATION & HEALTH RECORD FULL NAME: __________________________

DATE OF BIRTH (dd/mm/yyy): ________________

SEX: ___M ___F

HOME ADDRESS: _________________________________________________________________ _____________________________________________________

PHONE #: (___) ____________

Emergency Contact Information Person 2

Person 1 Name: Relationship: Phone # (H): (C): Address:

Name: Relationship: Phone # (H): (C): Address:

Participant Information: Child’s MCP#: ___________________________

Is child able to swim?: ___________________

Please list all medical conditions and/or allergies: _________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________

Booked by: _________________________ Note / Comments :

Date: ___________


Kid's Camp Registration & Health Record Form