Camper Registration

Hi! Thank you for your recent purchase for HWKND17! If you were sent this form, you have paid for multiple registrations and we are needing additional camper information from you! Please fill out the form below for each registered camper who we have not yet received a completed registration form from. No additional payment necessary. 

 

Please complete the form below

 
Name *
Name
Address *
Address
Phone *
Phone
Camper Birthdate *
Camper Birthdate
Emergency Contact Information *
Emergency Contact Information
Emergency Contact Phone #1 *
Emergency Contact Phone #1
Emergency Contact Phone #2
Emergency Contact Phone #2
HYC Camper Medical Information *
The following information is requested so that Hiawatha Youth Camp can best meet the physical, intellectual and emotional needs that may occur over the course of the summer. Per State of Michigan requirements, please fill out all information requested. Thank you! Check all that apply.
Please explain any areas identified above:
If yes, please list medications.
Health Insurance Company