2024 Highland Park Youth CampOnline Registration Form Camper First Name * Camper Last Name * Camper Email (optional) With your consent (below), email addresses are distributed at the end of camp so that campers may stay in touch with each other. Parent/Guardian Name * First Name Last Name Parent/Guardian Email * Home Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Parent/Guardian Primary Phone # * (###) ### #### Primary Phone Type * Home Cell Work Other Parent/Guardian Secondary Phone # (###) ### #### Camper Information Age * (At time of camp) Birthdate * Ages 12-18 only. Any questions or special requests, please contact info@highlandparkcampmeeting.org MM DD YYYY Grade Entering Fall 2021 7 8 9 10 11 12 Graduated Spring 2021 Medications Allergies or Physical Restrictions Local Church & Pastor (optional) Church Address (optional) Address 1 Address 2 City State/Province Zip/Postal Code Country Photo Waiver * I consent irrevocably to the use of my child's name or likeness, or testimonial on print materials or for future use on the Highland Park website. Yes No Email/Social Media Waiver * I consent to my child's email or social-media contact information being published in a password-protected area of the Highland Park Website for keeping in touch with other campers and staff after camp has ended. This may be rescinded at any time by contacting the Website Admin at support@highlandparkcamp.org. Your child's privacy is extremely important to us. Yes No Other Information or concerns Enter information in this area if you have any additional non-medical information you would like to share with our program director about your child. Medical information can be submitted on the medical information form that will be turned in later. Thank you! Your information has been sent to the Highland Park Youth Camp Program Director, Registrar, and Website Admin. We will email you information regarding camp in the weeks to come. No payment will be required for this year.
