Camp Registration

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Children*
Child's Name (first, last) Childs Birthday Friend Request (first, last)

Use the plus button to register multiple children.
Parents Name*
First Last
Home Phone
Cell Phone
Email*

Your confirmation will be sent to this email.

Emergency Info
Emergency Contact Name*
First Last
Emergency Contact Phone*
Emergency Contact Address*
Street Address Address Line 2 City State ZIP Code
Allergies
Please list any allergies.
Physician name and address.
Please enter the names, phone numbers, and addresses for your children's physicians.
Insurance
Policy Number
Emergency Medical Transportation*
- I consent.
In emergencies requiring medical attention your child will be taken to the NEAREST HOSPITAL. By checking the "I consent" box, you authorize the responsible person at CPCP to have your child transported to the hospital
Notes
Please add any additional notes here.
Photo Consent
I give consent to use photos and videos of my child.*
- Yes
- No

Emergency Info