Registration

Parent/Guardian Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Phone*
Child's Name*
First child's name - if you have more than 3 children please fill out a separate registration form for the second segment of children. Thank you.
First Middle Last
Birthdate
Month
Day
Year
Age
Second Child's Name
First Middle Last
Birthdate
Month
Day
Year
Age
Third Child's Name
First Middle Last
Birthdate
Month
Day
Year
Age
Days you want them to attend:*
You can select multiple days.
Are you using CCAP?
Health Insurance Provider:
Primary Care Physician
Primary Care Phone
In case of medical emergency, what's your preferred hospital/emergency care center?
Are your immunizations up to date?
Please upload Immunization records:
Max. file size: 20 MB.
Emergency Contact
Please up to 2 emergency contacts for your children.
Reminder*
After you finish your registration, don't forget to go to the menu to Kathy's Kamp
Check the box to confirm that you know to go and pay your registration fees.
https://familiesforwardco.com/kathys-kamp-payments/
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