Camp Registration

Camp Registration Form for the week of:(Required)

Fencer's Name(Required)

First Last

Club(Required)

Coached By(Required)

Birthdate(Required)

Gender(Required)

Male

Female

Other

Weapon(Required)

Foil

Épée

Sabre

Rating(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent/Guardian Information(Required)

First Name Last Name

Parent's Phone Number(Required)

Parent's Email(Required)

Enter Email Confirm Email

Emergency Contact(Required)

First Name Last Name

Emergency Contact's Phone Number(Required)

Doctor(Required)

First Name Last Name

Doctor's Phone Number(Required)

Health Insurance Company Name(Required)

Policy Number(Required)

The camper will take medication(Required)

Yes

List medication(s) and the condition(s) the medication(s) treats(Required)

Supervision required for administration of medication(s)(Required)

Yes

The camper has allergies(Required)

Yes

The camper is allergic to(Required)

Severity(Required)

Low

Medium

High

I have read the above Camp Policies, Legal Notices, and Photography Waiver and by signing below, I agree to abide them. (Please initial each)(Required)

Camper's Signature

Parent's Signature:

This field is for validation purposes and should be left unchanged.

Camp Registration Form

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