Camp Boomerang Camper Registration form

Select the date(s) you would like to register for *

Camper Details

First Name *

Last Name *

Street Address *

Address Line 2

City *

Zip Code *

Date of Birth *

Any Medical Conditions *

Yes

If "Yes" please specify(Put N/A if "No") *

Any Allergies *

Yes

if "Yes" please specify and list all allergies (Put N/A if "No")

Epi pen *

Yes

Does Camper require One on One? *

Yes

Camp Lunch *

Yes

Transportation *

Own transportation

Camp bus

Emergency Contact name *

Emergency Contact Last Name *

Relationship to Child *

Emergency Contact Phone Number *