Check the weeks of camp and send a deposit of $50.00 with registration form to reserve a spot.
Or send full payment of $190 week (KidsKamp) or $290 (X-TRA)

Name: _________________________________________________________________________

Phone___________________Address:____________________________________

City/Zip: ______________________________

Age: ______ DOB:________ Grade: ________ School: ___________________

Please note any medical condition:____________________________________________

Insurance Company:____________________________Policy # ____________________

Doctor's Name and #:_________________________________________________

Emergency Contact:___________________________________________________ 

I hereby authorize the staff of Kids Kamp to act for me

according to their best judgment in any emergency requiring medical

attention and hereby waive and release USF from any

injuries or illness while at the clinics. The camp staff has my permission to

seek any emergency treatment necessary for my child while in attendance at

KidsKamp.

Parent/Guardian Signature: ____________________________________Date:_________________

print this form, fill out, with a check in the amount of ______ payable to KidsKamp ir X-TRA and send to:

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