Pleasant Bay Camp - Children and Youth Summer Camp
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Gender*

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Please indicate if you have any other type of Insurance coverage*
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Does the Camper live at the address listed earlier in this Form?*
Who does the Camper live with?*
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Will medication be required at Camp?*
Does the Camper have any of the Following?*
Does the Camper have any physical, mental or emotional weakness or disability, chronic condition or recent illness which the staff should be aware of that may require attention?*
Has the Camper recently been exposed to infectious disease?*
Does the Camper have any allergies?*
Are the Camper's immunizations up to date?*
Does the Camper have any restrictions on swimming or other camp activity?*
By completing and submitting this Form, I am authorizing the Camp Nurse/Camp Director to act on my behalf in an emergency*
I have read and agree with the "Waiver of Conditions" as posted in the " Children's Camp" section under the "Waiver/Condition of Registration" Icon*
Select Your Camp Week*
Is Billing name and Address different than above?*
If you would like to Pay On-Line, after Submitting this Form visit the "Children's Camp Pay On Line ICON", if not pay at the Office. You must enter the "CODE" below to complete your application.


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