Camp Rock of Georgia

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Summertime at Camp Rock Registration

Summer Camp Registration

First Name

Last Name

Email

Phone

How many campers do you need to register?

Emergency Contact Info

Please provide information for an emergency contact other than yourself.

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone

Camper 1 Information

First Name

Last Name

Which camp will this camper be attending?

6th-8th Grade Girls (June 23-25)

6th-8th Grade Boys (June 25-27)

3rd-5th Grade Boys (July 21-24)

Camper Grade

Camper Age

Camper Gender

Camper Shirt Size

Please explain any sleep issues.

Please explain any behavior or discipline issues.

Please explain any medication or allergies.

Is this camper in foster care?

Yes

No

Can this camper swim?

Yes

No

Image Release

Yes

No

Please upload an image of the child’s insurance card.

Choose File

Camper 2 Information

First Name

Last Name

Which camp will this camper be attending?

6th-8th Grade Girls (June 23-25)

6th-8th Grade Boys (June 25-27)

3rd-5th Grade Boys (July 21-24)

Camper Grade

Camper Age

Camper Gender

Camper Shirt Size

Please explain any sleep issues.

Please explain any behavior or discipline issues.

Please explain any medication or allergies.

Is this camper in foster care?

Yes

No

Can this camper swim?

Yes

No

Image Release

Yes

No

Please upload an image of the child’s insurance card.

Choose File

Camper 3 Information

First Name

Last Name

Which camp will this camper be attending?

6th-8th Grade Girls (June 23-25)

6th-8th Grade Boys (June 25-27)

3rd-5th Grade Boys (July 21-24)

Camper Grade

Camper Age

Camper Gender

Camper Shirt Size

Please explain any sleep issues.

Please explain any behavior or discipline issues.

Please explain any medication or allergies.

Is this camper in foster care?

Yes

No

Can this camper swim?

Yes

No

Image Release

Yes

No

Please upload an image of the child’s insurance card.

Choose File

Let’s Get Connected!

1736 W Gordon St
Valdosta, GA 31601
Phone: 229-244-1920
info@camprockga.com

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