Participant Information

Name:
Address:
Gender:  Age :
Religion:
Date of Birth:
(dd/mm/yyyy)
School:

Family Information

Father's name:
Ocupation:
Place of Work :
Work Phone:
Mother's Name :
Ocupation:
Place of Work
Work Phone :

Medical History

Any infectious disease or illness:

Allergies:

Foods child should'nt eat or drink:

Medications child should'nt eat or drink:

Blood type:

Child's doctors name:

Clinic or hospital:

Phone:

In case of emergency who should we call::

Name:
Phone:
Address:
Relationship:

The suscriber requesting inscription to "Comatillo Summer Camp" via email for a period of weeks from date to date and declare that is responsable for the child subject to the application, and agrees knows and understand all camp's rules and regulations.

Comments and/or Special Instructions: