Summer Camp Registration

* Indicates required field

Camper Name *

First

Last

Camper Date of Birth *

Camper School (attended or will be attending) *

Camper allergies or important medical information *

For internal and external use, I acknowledge that Families First Learning Lab and or its sponsors and partner organizations may utilize photographs and or video footage of the member or a family member, which may be taken during involvement in Families First Learning Lab's programs or activities. I also acknowledge Families First Learning Lab and or its partner organizations may utilize information regarding a member’s story or experiences to highlight and promote the value and impact of the programs and/or activities at Families First Learning Lab. I consent to such uses & herby waive all rights to compensation. *

I agree and consent I do not agree nor consent

Parent Name *

First

Last

Parent Email *

Parent Phone Number *

Emergency Contact 1 Name *

First

Last

Emergency Contact 1 Phone Number *

Emergency Contact 2 Name *

First

Last

Emergency Contact 2 Phone Number *

Camp Registration *

If Other is selected, please let us know which camps you would like to register for. Make custom payment on next page. *

Submit