Summer Camp Contact & Medical Form

We’re excited to welcome your camper!

Please fill out the secure form below to complete your camper’s registration.
You can also download and complete a PDF of the form to bring to the first class.
The instructor will contact you in advance of class to confirm attendance and form completion.

Thank you!

Camper's Name(Required)

Camper's Age / School Grade (entering in fall)(Required)

Parent / Guardian Name(Required)

First Last

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Email(Required)

Daytime Phone(Required)

Other Phone(Required)

If the same as daytime phone, please enter again here. Thank you!

Please enter all drug, food allergies and/or dietary requirements:

If your camper has medical or other conditions the staff should know about please share them here:

Please note if your camper carries either of these devices:

Epi-Pen

Inhaler

Will your camper need to take any medications during camp time?(Required)

Yes

If yes, please note time and dose amount here:

Physician Name

First Last

Physician Phone Number

Emergency Contact (other than yourself):(Required)

Emergency Contact Phone Number

Photo / Media Waiver(Required)

I give Somerset Artists’ Co-Op permission to use photographs or video made during Camp for promotional purposes. I understand the images may be used in local newspapers, internet, or Co-Op programs. The Co-Op will not sell, give away these images, or use in any manner other than described above.

Yes

Signature(Required)

Typing your name into the field below will represent your digital signature on this form submission.

Yes! Please subscribe me to the Somerset Artists' Co-Op email list.

I understand my email will not be shared with third-parties without my express permission.

Subscribe Me!