Camper Contact & Medical Form

Camper Information

* Indicates required field

Name *

First

Last

Grade entering in September *

Camper T-shirt Size *

Where did you hear about Raynham Stables Summer Camp? *

Age *

Gender *

Female Male Other

Contact Information

Parent/Guardian

Name *

First

Last

Mailing Address *

Cell Phone Number *

Email *

Secondary Phone Number *

Emergency Contact (will only be used if parents cannot be reached)

Name *

First

Last

Phone Number *

Relationship to Camper *

Medical Information

Name of Doctor: *

Does the camper have any allergies? *

Yes No

If yes, please list: *

Phone Number *

Please list any other physical, mental or emotional concerns we should be aware of: *

Submit