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RKMCC Summer Camp Age 10 Registration Form

Child Camper Information (Only for 10 years old)

Name of Child
Date of Birth
Are you finanical member of RKMCC?
Select which week (s) your child would participate in summer camp (Select all that apply)

Parent/Guardian Information

Name of Parent
Address
Would you (or another family member) be open to volunteer during this camp?

Emergency Contact

Name
Does your child have any food allergies or dietary restrictions? Note: vegetarian lunch and snacks are provided during camp. Every effort will be made to accommodate food restrictions, but if your child has severe restrictions, please provide a vegetarian lunch and snacks from home.
Does your child suffer from any other allergies, illness, disability or other medical conditions?
I understand that although I am enrolling my child in a specific age group, they may be placed with children of different ages depending on enrollment numbers.
Please pay now