Kids Care Day Camp Program 2023

1Child Info > 2Parent/Guadiran Info > 3Pick Up Persons > 4Emergency Contacts > 5Policies > 6Terms of Use > 7Field Trips
Child Information
Membership

Membership New Renewing
Gender

Gender Female No
Name Name First Middle Last
Date of Birth Date of Birth / MM / DD YYYY
Child's Age
Address Address
Street Address City Zip
Child's Medical Information

***PLEASE WRITE NONE OR SPECIFY WHERE NEEDED***
Food-Medication Allergies
Current Medications
Physical/Developmental Disability
Activities my child is unable to participate in
Current Immunization, Vision and Hearing Records are on file at
Photo/Media Permission
I give permission for my child to be included in promotional/ media resources, pictures, recordings regarding Camp Fire West Texas Kids Care program

I give permission for my child to be included in promotional/ media resources, pictures, recordings regarding Camp Fire West Texas Kids Care program Yes No
Do you have any siblings in the program?

Do you have any siblings in the program? Yes No
Siblings' full name:
Save my progress and resume later
Enter Your Email Address *

A special link to resume the form will be sent to your email address.