Camp Ambleside Signup

Camp Ambleside Registration

Parent / Guardian's Name(Required)

First Last

Phone(Required)

Email(Required)

Parent / Guardian Employer

Employer Phone

Parent / Guardian's Name

First Last

Cell Phone

Child's Name

Child's DOB

Child's Name

Child's DOB

Child's Name

Child's DOB

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Emergency Contact(Required)

First Last

Emergency Contact's Phone(Required)

Does your Child have allergies?

Yes

If yes, list

Does your Child have any medical conditions that would require medication?

Yes

If yes, list

Who is authorized to pick up your Child from Camp?

List full name and relationship to camper

Check Box to specify payment method

Paid via Venmo @amblesidecv

Will Pay with Check

Will Pay with Cash