Our season has come to a close. Thanks for visiting, and we hope to see you again next season!

Summer Camp Registration

Camper name

Camper age

Week

Parent / Guardian name

Phone

Address

City

State

Zip

Shirt size

Emergency Contact

Contact 1

Contact 1 full name

Contact 1 phone number

Contact 1 relationship to camper

Contact 2

Contact 2 full name

Contact 2 phone number

Contact 2 relationship to camper

Additional Information

Who whill pick up the camper?

List any allergies (optional)

List any medications taken in a regular basis (optional)

Does your child have asthma?

Does your child have diabetes?

Do you authorize the use of sunscreen at Camp CCA, and do you authorize Camp CCA staff to assist your child in applying sunscreen?

Does your child require a Epinepherine Auto-Injector to be carried on their person or kept on site? (Optional)

Physician's name (Optional)

Physician's phone (Optional)

In the event of an accident or if your child becomes ill, we will notify who has been listed on the emergency form. If we are unable to contact anyone and we feel that your child needs medical care, do you give us permission to seek medical help?

I hereby grant to Corn Cob Acres, its representatives, and employees the right to take photographs/ videos (through all means including the use of drones) of my child in connection with my child's participation in the activities. I hereby authorize Corn Cob Acres to copyright, use, and publish the same in print and/or electronically. I hereby agree that Corn Cob Acres may use such photographs of my child for any lawful purpose, including but not limited to publicity, illustration, advertising, and Web content.