Sea Beans Camp

First name

Last name

Age

Parent/Guardian Name

Parent/Guardian Email

Parent/Guardian Phone

Emergency Contact #1 Name

Emergency Contact #2 Name

Emergency Contact #1 Phone

Emergency Contact #2 Phone

Emergency Contact #1 Relationship

Emergency Contact #2 Relationship

Does your child have any allergies or underlying medical conditions that we should be aware of? If so, please list them below

Does your child have medical insurance? If so, please state the insurance company.

Who is your preferred doctor for your child?

I agree that I will not hold FRIENDS liable for any accident, injury or illness that may occur during summer camp.

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