Register for Camp

The St Jude Elementary Summer Camp Registration Form


Parent (Last, First):
Camper (Last, First):
Address:
City,State,Zip:
Mom Cell:
Dad Cell:
Emergency number:
Contact Email (only one):
School:
Grade (2022-2023 school year):
Shirt Size:
Weeks Attending:
Camper Gender:

Physician's Name
Physician's Phone Number
Dentist's Name
Dentist's Phone Number
Medical Insurance Company
Policy Number
Please list Medical conditions you feel we should be aware of
My child/ward may participate in all Program activities except
I have read and agree to the Medical Release	(Check box and sign full name)
I have read and agree to the Release and Hold Harmless	(Check box and sign full name)