Kolin Summer Camp Registration Form 2007
Camper’s name:____________________ Address:________________________________
Sex:_______ Age:_______ DOB:_________ School Last Attended:________________
IN CASE OF EMERGENCY, CONTACT:_____________________________________
(parent or guardian)
Phone (wk)____________ Home:___________ Cell:____________ other:___________
Additional emergency contact:_______________________________________________
Phone: (Wk)______________ Home:_____________ Cell:____________other:_______
My Child is allergic to:__________________________________________________
I, the parent/guardian of the registrant, a minor, agree that I and the registrant will abide by
the rules & regulations of the Kolin Summer Camp & its instructors. I authorize Kolin
Learning Center/Summer Camp to care for my child during the time he/she is in the camp
or participating in a camp sponsored field trip & to administer & obtain emergency medical
treatment for my child in the event that I cannot be reached. I also authorize Kolin
Learning Center/Summer Camp to transport my child to & from camp sponsored field trips.
________________________________________________________________________
Parent/guardian signature date:
Parent/______________________________
Water Activities Permission Form
My child/children__________________________has permission to participate in the
following type of water activity: Daily swimming for fun in the Ruby Wise Elementary
School Swimming Pool. The Swimming Pool is located on the Ruby Wise Elementary
School Ground. Types of water activities will included swimming for fun under lifeguard
supervision.
____________________________ _________________
Parent Signature Date
____________________________ _________________
Parent Signature Date