47 entries left

Participant *

First

Last

Gender

• Female
• Male

Grade Level *4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th Grade

Age *

Birthdate *

T-Shirt (Adult Size)

• XS
• S
• M
• L
• XL
• XXL
• XXL

List All Allergies (including allergies to Food and Medications) *

List All Current Medications this child is taking *

Medical History (i.e recent surgery, diabetes, chronic illness) *

Is there anything we should know about this child that might help is during activities (i.e. paralyzing fears, ADHD, Asperger's Syndrome, etc) *

As legal guardian I give the following emergency medical consent for my child fromAugust 23, 2023 to August 21, 2024 *

• Emergency Surgery and First Aid
• First Aid Only

Primary Legal Guardian

Legal Guardian #1 *

First

Last

Legal Guardian #1 Address *

Address Line 1

Address Line 2

City

--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Legal Guardian #1 Phone *

Legal Guardian #1 Other Phone Number

Optional

Guardian Email *

Email

Confirm Email

Secondary Legal Guardian

Is there another LEGAL GUARDIAN for the above child? *

• No
• Yes

Legal Guardian #2 *

First

Last

Legal Guardian #2 Address *

Address Line 1

Address Line 2

City

--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Legal Guardian #2 Phone *

Legal Guardian #2 Other Phone Number

Optional

Legal Guardian #2 Email *

Email

Confirm Email

Medical Information

Medical Insurance. Name of Legal Guardian who has the Medical Insurance *

Employer (if insurance is through work) *

Medical Insurance Provider

Medical Insurance Phone Number *

Medical Insurance ID and Group Number *

Website

Submit