2023 Summer Adventure Camp Registration Section 1: Camper Information
(Please complete a separate form for each camper you are registering)
Section 2: Parent/Guardian Information
(This person will serve as the primary contact; they are also the primary emergency contact & they are an authorized driver)
Relation to Camper
How did you hear about Beech Creek Adventure Camp?
If yes, complete address below
Section 3: Additional Parents/Guardians & Emergency Contact Information
(Please provide at least one additional emergency contact in this section, different than the primary contact listed above)
Relation to Camper
Relation to Camper
Relation to Camper
Section 4: Camper Health & Medical Information
(Select all that apply)
If your child has an allergy, please specify the allergy here.
If your child has any existing conditions, please explain them here.
List any addtional specific medical, physical, emotional, or behavioral conditions that need to be considered.
List any medications your child will be bringing to camp.
Please explain any reasons your child's activity should be limited.
In the event that paramedics are called please list all medications currently taken by your child.
Medication Name
Dosage
How often?
Time Taken
Reason Taking
Medication Name
Dosage
How often?
Time Taken
Reason Taking
Medication Name
Dosage
How often?
Time Taken
Reason Taking
Medication Name
Dosage
How often?
Time Taken
Reason Taking
Section 5: Camp Dates Attending
(Select all that apply)
Please select only the camp dates that you paid for during online checkout.
If a camp date you had wanted to register for reached its limit during checkout, please indicate if you would like to be added to the waiting list by completing the wait list section.
