Soul Skills Summer Girls Camp
Registration Form

Summer 2024
June -3rd- June 21st

Contacts

Parent Name *

Address *

Phone Number *

Email *

Parent Name

Address

Phone Number

Child

Child's Name *

Address *

Phone Number *

Email *

Child’s Age *

Child’s School *

This Child identifies as a female? *

Yes

Authorizations

Person other than Parent Authorized to Pick up your Child from Camp:

Name

Relationship to Child

Address

Phone Number

Workplace

Are there Persons not Authorized to pick your child up?

Name

Relationship to Child

Health and Emergency

Doctor's Name

Doctor's Address

Doctor's Phone

Dentist's Name

Dentist's Address

Dentist's Phone

First choice of hospital

Hospital Address

Hospital Phone

Insurance Provider

Insurance Group Number

Insurance Policy Number

In case of Emergency we will

Call you
Call your Doctor
Call 911

Do you have other further instructions in the case of an emergency?

Do you grant permission for us to seek medical treatment of your child via the primary care physician and/or transport your child to the hospital in the case of an emergency?

Yes

Does your child have any medical concerns?

Does your child take any medications?

Does your child have any allergies?

Has your child had any recent medical concerns or hospitalizations?

Any other concerns you would like us to know about?

Emergency Contact Name

Relation to camper

Address

Phone

Workplace

Emergency Contact Name

Relation to camper

Address

Phone

Workplace

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Soul Skills Summer Girls Camp Registration Form

Contacts

Child

Authorizations

Health and Emergency

Soul Skills Summer Girls Camp
Registration Form