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PVUMC

 

 

 

 

 

 

 

 

Please complete the following form, and when complete “click” or “tap” the submit button on the bottom of the page.  Please be a little patient – it takes some time for the website to format the information and write it to the on-line database.  After your information has been recorded, you will be taken to a new page which will provide you with information the ‘next steps.’

 

 

 

Camper's Information

Campers Name:

 

First

Last

Campers Birth Day

Month

Day

Year

Age

 

 

 

 

 

School Attending in Fall

Grade in Fall

Gender

Shirt Size

 

 

Mother’s Information

Mothers Name

Cell Phone

 No Spaces - Example (480)123-4567

Work Phone

 No Spaces - Example (480)123-4567

Father’s Information

Fathers Name

Cell Phone

 No Spaces - Example (480)123-4567

Work Phone

 No Spaces - Example (480)123-4567

Contact Information

Street Address

City

Zip

Primary E-Mail Address

Second E-Mail Address (optional)

Home Phone Number

 Example (480)123-4567

Allergies and Medications

Please Note - There is NO nurse on Campus; therefore we may not administer any medication

Allergies - if none, please indicate None

 

 

 

 

 

 

 

 

Medications - if none, please indicate None

 

 

 

 

 

 

 

 

Emergency & Doctor’s Information

In the event that we cannot reach you, please provide the names of two people that we can contact in case of an emergency or sickness:

Emergency Contact #1

Name

Phone 1

 No Spaces - Example (480)123-4567

Phone 2

 No Spaces - Example (480)123-4567

Emergency Contact #2

Name

Phone 1

 No Spaces - Example (480)123-4567

Phone 2

 No Spaces - Example (480)123-4567

 

 

Doctor’s Name:

 

Phone Number

 No Spaces - Example 480-123-4567

Permissions

My child has my permission to be photographed for camp publicity, i.e. campus fairs, campus newspaper, and local newspapers, camp web site and magazines.

 

 

 

 

 

 

 

 

 

In the event that I cannot be reached in an emergency, I Here by give permission for Imagine That! Summer Camp staff to secure medical treatment for my child.

 

 

 

 

 

 

 

 

Camp Selections

Session I Camps June 1st through June 18th

Jump Start

Morning Session:

Friend Request

Choice 1

Choice 2

Afternoon Session:

Friend Request

Lunch Bunch

 

Choice 1

Choice 2

Gymnastics

Session II Camps June 22nd through July 2sd

Morning Session

Jump Start

Friend Request

Choice 1

Choice 2

Afternoon Session

Lunch Bunch

 

Friend Request

Choice 1

Choice 2

Gymnastics

 

 

 

 

 

 

 

 

Again, please be a little patient – it takes some time for the website to format the information and write it to the on the database.