Summer Camp Application

Child’s Name: ____________________________________

Address: _______________________________________

______________________________________________

Birthdate: ______________________________________

Age: ________   M or F (circle one)

Grade Level: ________________________

Parent’s Names: __________________________________

______________________________________________

eMail Address: ___________________________________

Home Phone #: ___________________________________

Work Phone #: ___________________________________

Emergency Phone #: _______________________________

Child to be picked up by: _____________________________

_______________________________________________

T-shirt size: ______________________

Date of Camp: _____________________________________

Medical conditions or Allergies we should know about:  ________________________________________________

________________________________________________

Do you keep Kosher? ______________________________

I do / do not give permission for my child’s picture to be used for promotional materials for Legare Farms Summer Camp.  These pictures maya be used on our web site, Facebook page or other promotions.

Signed: ___________________________________________