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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?
– Select –
1
2
3
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
– Select –
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Camper Age
Camper Gender
– Select –
Male
Female
Camper Shirt Size
– Select –
Youth Small
Youth Medium
Youth Large
Youth XLarge
Adult Small
Adult Medium
Adult Large
Adult XLarge
Adult XXLarge
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
– Select –
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Camper Age
Camper Gender
– Select –
Male
Female
Camper Shirt Size
– Select –
Youth Small
Youth Medium
Youth Large
Youth XLarge
Adult Small
Adult Medium
Adult Large
Adult XLarge
Adult XXLarge
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
– Select –
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Camper Age
Camper Gender
– Select –
Male
Female
Camper Shirt Size
– Select –
Youth Small
Youth Medium
Youth Large
Youth XLarge
Adult Small
Adult Medium
Adult Large
Adult XLarge
Adult XXLarge
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
Submit Form
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