K.I.A. Enrollment

Child Name

Age

Mother/ Father Names

Mother/ Father Phone #

Mother/ Father Valid E-mail

Non-Parent Emergency Contact

Emergency Contact Phone #

Other Persons Authorized to Pick Up from Camp

Other Things We Might Want to Know (ex: Can swim / food allergens, meds to be administered, health issues)

Please initial that you understand the activity fee rate structure

Will your child be full-time or part-time?

Shoe Size (bowling shoes)