Fun & Freedom Day Camp 1st-6th Grade

Campers Name *

First

Last

Gender *

Current Age

Birthday (mm/dd/yyyy) *

Current Grade *

What School District does your child attend:

CAMPER T-Shirt Please check one: *

Parent / Guardian Name: *

First

Last

Address: *

City, State, Zip

Email *

Cell Phone

Home Phone

Emergency Contact: *

First

Last

Emergency Contact Phone

Did Your Child Attend our Day Camp before? *

If YES – which team:

Does your child have any siblings that will be participating or have participated in Day Camp: *

Known Allergies: *

Medications (i.e. Inhaler, EpiPen etc.): *

What would you like your child to get out of camp:

Tell us anything else you would like us to know about your camper:

Fun and Freedom is a 501(C)(3) non-profit organization.

P.O. Box 63
Tarentum, PA 15084

724.274.7773

Mon. - Fri. 8AM - 6PM