CAMP REGISTRATION
Participant name
Parent/Guardian E-Mail
Address
Emergency Contact if different from above
Name of School
Medical Insurance Company
Policy Holder's Name
Medical Doctor's Name
I accept JGSC release/waiver
Parent/Guardian name
Parent/Guardian Phone Number
City, State & Zip Code
Grade/Age
Emergency Contact Phone Number
Any restrictions on participation
Policy Number
Relationship to Participant
Medical Doctor's Phone Number
I accept VK release/waiver
Thank you for registering!
Submit form & pay registration fee
Date of Birth
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