Camp Anderson Anchored - Camp Sign Up

Camp Anderson Anchored Registration 2021

First Name

Last Name

Checkboxes
Male
Female

Age

Birth Date

School

Grade

Address

Cell Phone

Home Phone Number

Parents/Guardians Name

Parents/Guradians Name Phone Number

Emergency Contacts Name

Relationship

Emergency Contacts Phone Number

Does Your Child Have A Disability

If So, Please Explain

Are there any concerns( physical/social,etc.) of which we should be aware in order that we may assist in your campers adjustment in the camp.

Allergies (Food, Drugs, Etc)

Medication