Registration Form, The Kent Cummins Magic Camp

Camper Information Form

All fields are required unless marked optional.

First Name
Last Name
Prefers to be called optional
Gender
Age at Camp
Birthday (format: mm-dd-yyyy)
Address
Address 2 optional
City
State
Zip Code
Phone
Email
Grade Completed by Camp Start Date
School Attended
Previous Camper
Where did you hear about The Kent Cummins Magic Camp? optional
T-Shirt Size
Tell us about your child's special needs, diet restrictions, and medications. optional
Campers are generally grouped by age and experiences. If you want your camper grouped with another specific camper, please list the name of the reason for the request. We reserve the right to place campers where we think they will benefit most. optional

We Work MAGIC with Kids!^sm

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