Register for Camp

Royalmont Academy Laffalot 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 (2021-2022 school year):
Shirt Size:
Weeks Attending:
After/Before Care :
Camper Gender:
Promotion Code:

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)