THE IMAGINE FOUNDATION PRESENTS:
Camper Information Form
Name or names: ____________________________
___________
Address:
Email
Grade completed ______
Age _______
School:
Camper info:
Food Allergies:
Other health concerns:
Local Physician:
Family Contact Numbers:
Emergency Contact Numbers:
My child has permission to travel to and from camp alone:
These people may pick up my child:
____ My child may travel by car to the downtown area with camp staff and volunteers
____ Imagine may use photos of my child in publicity, grant reports and on Facebook
Parent Signature: