Kingsbury Club & Spa Camp Registration

CAMPER'S NAME:	*
BIRTHDATE:
ADDRESS:
CITY:
STATE:
ZIP:
PARENT/GUARDIAN:
HOME PHONE:	*
WORK PHONE:
EMAIL:	*
MEMBERSHIP TYPE:	All Inclusive     Other Member     Non-Member
PAYMENT METHOD:	House Charge     Check     Credit Card
CAMP:	The Camp at Kingsbury     Kiddie Camp
KIDDIE CAMP SESSIONS:	Session 1: June 29 - July 3 Session 2: July 6 - July 10 Session 3: July 13 - July 17 Session 4: July 20 - July 24 Session 5: July 27 - July 31 Session 6: August 3 - August 7 Session 7: August 10 - August 14 Session 8: August 17 - August 21
THE CAMP AT KINGSBURY SESSIONS:	Session 1: June 29 - July 3 Full    Half Session 2: July 6 - July 10 Full    Half Session 3: July 13 - July 17 Full    Half Session 4: July 20 - July 24 Full    Half Session 5: July 27 - July 31 Full    Half Session 6: August 3 - August 7 Full    Half Session 7: August 10 - August 14 Full    Half Session 8: August 17 - August 21 Full    Half
T-SHIRT SIZE:	Youth S      Youth M      Youth L
Please explain any medical conditions or restrictions we should be aware of:

Please note: Parent/Guardian will be required to sign the folIowing:
I accept fully that the Kingsbury Club, its shareholders, directors, officers, employees, representatives and agents cannot be held responsible for any and all loss, claim, injury, damage, or liability sustained or incurred by my child during their participation on premises or off.
In the event I cannot be reached in an emergency, I hereby give permission for the Kingsbury Club to secure proper treatment for my child.

All campers are required to fill out a medical form provided by The Kingsbury Club.