Name: *
Name:
Approved Pick-up List:
Parent/Guardian Name 1: *
Parent/Guardian Name 1:
Parent/Guardian Phone 1: *
Parent/Guardian Phone 1:
Parent/Guardian Name 2:
Parent/Guardian Name 2:
Parent/Gaurdian Phone 2:
Parent/Gaurdian Phone 2:
Emergency Contact 1: *
Emergency Contact 1:
(Example: "Nanny" or "Older Sister")
Emergency Contact 1 Phone: *
Emergency Contact 1 Phone:
Emergency Contact 2:
Emergency Contact 2:
Emergency Contact 2 Phone:
Emergency Contact 2 Phone:
(Example: "Nanny" or "Older Brother")
Brief Camper Medical History
(Please complete each section in detail. If no allergies or restrictions, please write “NONE”. Please note that NCMS is not authorized to issue any medication on-site.)
Please list all known allergies including food, medications, seasonal etc.
Please list any restrictions in regards to camp activities.
My electronic signature below indicates that the above information is correct and complete to the best of my knowledge. This electronic signature gives the above camper permission to take part in all camp activities, be picked up by the contacts listed above after the presentation of a photo ID, and to be a part of any photos and/or videos taken by NCMS. My electronic signature below also indicates my agreement with all school policies listed on our website: www.nashuacms.org/registrationpolicies.