Register for Camp Blue Ash Rec Center Learning Camp Registration Form Parent (Last, First): Camper (Last, First): Address: City,State,Zip: OH KY IN MI Mom Cell: Dad Cell: Emergency number: Contact Email (only one): School: Grade (2024-2025 school year): -Please Select- First Second Third Fourth Fifth Sixth Shirt Size: -Please Select- Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Weeks Attending: -Please Select- July 8-10, 2024 July 29-31, 2024 Both Camper Gender: -Please Select- Female Male 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)