November 24 PD Day Camper Info Form

November 24 PD Day Camp - Camper Info Form 2023

Location: North Bay Nordic Ski Club, 630 Northshore Rd.

Please only complete AFTER completing payment for spots(s). You do not need to complete if child attended our summer 2023 day camp program. This form does not secure your child's spot. If the items are not available in the store, the program is full, but you may submit a wait list form at the bottom of payment page.
Please submit a separate form for each child you are registering.

* Indicates required field

Child's Name *

First

Last

Date of Birth (YYYY-MM-DD) *

Parent's Name *

Phone Number *

Additional Parent's Name *

Phone Number *

Email *

Email for additional household *

Does the camper have a medical condition? *

Yes No

Details *

Is the camper on any medication? *

Yes No

Details *

Dietary Concerns/Conditions (ie. Allergies, Dietary Restrictions) *

Is there anything we should know about the camper? *

If at any time emergency medical treatment is necessary for my child, I give consent for treatment to be given. Every effort will be made to contact parent/guardian(s) and/or emergency contacts. *

Yes No

Camper Health Card Number *

Emergency Contact (If parents can not be reached) *

First

Last

Phone Number *

Relationship *

In my/our absence, I authorize the following people to pick up my child *

First

Last

Phone Number *

Relationship *

Additional Comments *

Submit

This form does not secure a spot. Be sure to complete payment and date selection first.