Adventure Camp Registration Form
Camp Date From July 20th to July 27st
 From August 1 st to August 7th
Registration Date (day)
(month)
(year)
Method of Payment Transfer
 Cash
 PayPal
 Credit card
Include additional payment for the service of Private Transportation León International Airport - San Miguel ( Ask for the price)
The child has permition to  Swim
 Rappel
 Horseback Riding
Nickname
Birthday
Place of birth
Age:
Grade
Number of siblings
Camper 's Name
Parents Information: Mother' Name(s)
Mother's Email
Telephone
Cellphone
Office Phone Number
Father's Name
Father's Email
Cellphone
Office Phone Number
Adress
Neighborhood
State
Zip Code
District
In case of living separately, specify with whomm does the camper live
Person whom should be contacted in case of emergency: Name
State
Kinship
Emergency Phone Number
Emergency Cell Phone Number
Emergency Email
Will you attend to the awards and closure ceremony? Yes
 No
How did you fin out about our Adventure Camp?
Could you write 2 recommendations of possible interested campers for AdventureCamp?
Name of the candidate 1
Phone Number
Candidate's Email
Name of the candidate 2
Phone Number
Candidate's Email 2
Medical Information: Blood Type
Height
Weight
Name of private physician
Doctor's Cellphone Number
Office Phone Number
Doctor's Email
Is the camper allergic to any... Medicine
 Animal
 Plant
 Food
Other allergy - Specify
Vaccines Triple
 Measles
 Tetanus
Other vaccine - Specify
Suffered diseases Rubella
 Hepatitis
 Measles
 Chicken Pox
Other disease - Specify
Chronical disease Asma
 Epilepsy
 Diabetes
 Migraine
 Hearth
 None
Other chronical disease - Specify
Indicate if the camper has had any surgery performed last year
Additional remarks
Medicines that should be administered during the AdventureCamp
Medicine 1
Doses
Schedule of Drug 1 administration
Medicine 2
Schedule of Drug 2 administration
Doses 2
Indicate the reason why this drugs should be administered
Indicate if there is any special medical attention required
Enter the code as it is shown



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