Fran Camp 2020

FranCamp 2020 Registration

Camper Registration ($250.00)
Camp registration includes transportation, lodging, meals, activities

Students Name

Student Phone Number

Date of Birth

GRADE COMPLETED BY JUNE 2020

Gender

T-shirts are no longer available

HOUSEHOLD INFORMATION

Parent/Guardian Name

Parent Email

Parent Primary Phone

Parent Secondary Phone

Address

Emergency Contact Person

Emergency Contact Relation

Emergency Contact Phone

PHYSICIAN & INSURANCE INFORMATION

Physician Name

Phone Number

Date of Most Recent Tetnus Vaccination

Insurance Carrier/Plan Name

Insurance Group#

Insurance Carrier Address

Name of Insured

Name of Policy Holder