Mansfield State Historic Site-Kids Day Camp Signup

Mansfield State Historic Site-Kids Day Camp Signup

Please complete all required camper, parent/guardian, emergency, medical, permission, and signature information. Once registered and paid you will receive a camp schedule by e-mail. The camp will be held July 10th and 11th from 9:00 AM-1:00 PM. After signing up campers will receive a full schedule the week prior to camp.
Camper Information
Child's Full Name

First NameLast Name
Preferred Name / Nickname
Date of Birth

MonthDayYear
Date
Age
Grade (if applicable)
Camp Date(s)
T-Shirt Size
Parent / Guardian Information
Parent / Guardian Name
Relationship to Child
Primary Phone
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contacts
Emergency Contact 1 Name
Emergency Contact 1 Relationship
Emergency Contact 1 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact 1 Authorized for Pickup
Emergency Contact 2 Name
Emergency Contact 2 Relationship
Emergency Contact 2 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact 2 Authorized for Pickup
Medical & Special Needs
Allergies, medical conditions, dietary restrictions, or special instructions
Medications camp staff should be aware of
Physician's Name and Phone Number
Permissions & Authorizations
Consent to Emergency Contact
Participation Permission
Photo Permission
Signature Section
Parent / Guardian Signature
Date

MonthDayYear
Date
Printed Name
Office Use Only (optional/hidden)
Paid
Form Complete
Notes
Should be Empty:

Mansfield State Historic Site-Kids Day Camp Signup

Camper Information

Parent / Guardian Information

Emergency Contacts

Medical & Special Needs

Permissions & Authorizations

Signature Section

Office Use Only (optional/hidden)