BHGC Summer Camp Registration

Parent Full Name *

Email *

Phone *

Address

City

State

Postal Code

Child Full Name *

Child's Age

Choose one or more options

Child Allergies

Medical Conditions

Does Your Child Require an EpiPen? *

Yes

No

Emergency Contact Name *

Emergency Contact Phone *

Choose Your Attendance Schedule *

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Would Your Child Like to Attend With a Friend?

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