Root and Rise Summer Camp/Workshop Enrollment

 Summer 2024

IF ENROLLING MORE THAN ONE CHILD OR ADULT, PLEASE FILL OUT A SEPARATE FORM FOR EACH PERSON

Participants First & Last Name

Parent's Email

Participants Birth Date

Phone

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Country

Country

EMERGENCY CONTACTS

1) Full Name

2) Full Name

3) Full Name

PRIMARY PHYSICIAN

Phone

Phone

Phone

Phone

Please list any allergies your child has

Please list any medications your child is currently taking

Any other information you would like for us to know about your child?

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