SNACCC Camp registration form

Camper 1

First

Middle

Last

Preferred name

Date of Birth

Entering Grade

Allergies

Medications

Dietary Restrictions

Adult T-Shirt Size

Small

Medium

Large

X Large

XX large

Camper 2

First

Middle

Last

Preferred name

Date of Birth

Entering Grade

Allergies

Medications

Dietary Restrictions

Adult T-Shirt Size

Small

Medium

Large

X Large

XX large

Parent/Guardian

First

Middle

Last

Address

City/Town

State/Province

ZIP/Postal Code

Parent/Guardian phone number - Cell

Parent/Guardian phone number - Office

Authorized Pick up Person(s)

1. Authorized pick up person(s) name and phone number

2. Authorized pick up person(s) name and phone number

3. Authorized pick up person(s) name and phone number

Additional information we should know about your child(ren)?

Directions to complete the application:

Complete on line registration form and make payment through Touchnet.
Download and complete all State of Maryland or NDMU camp forms including Medication Administration Authorization Form, Camper Health History Form, Behavior Policy Acknowledgment Form, and Photography Release Form on the camp website. Email completed documents to janastasi@ndm.edu

Camp is limited to the first 30 campers who have submitted all of the required documentation and made payment in full. See you this Summer!!!

Camper 1

Camper 2

Parent/Guardian

Authorized Pick up Person(s)

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