Kamp Knox Registration Form

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August 16-20 2010 9:00 AM to 12:00 PM

Cost is $10 per child.

Where there are more than two children from the same family $10.00 for the first 2 and $8.00 for the rest.

* Required information.

Child's Name (First Last) *
Child's Date of Birth *
Grade
Parent's Name *
Street Address *
City *
Postal Code *
Home Phone *
Work Phone
Cell Phone
Email address *
In case of an emergency we can also contact (Name and Number) *
Child's Health Card # *
Known Allergies *
Special medical conditions or medications that Kamp Knox Staff should be aware *
Is there anyone we should consider putting your child with?
Photo-Video Permission (Change to No, if not permitted)
Mailing List Permission (Change to No, if not permitted)
Would you like to volunteer? (Yes, and we'll contact you)

Hover over the left image and enter the security code into the right textfield.