2017 Circus Camp Registration Form - Please fill this out for each individual attending camp once you have signed up and paid via FrontDesk.

Which camp/s are you registering this camper for? (check all that apply) *
Camper Name *
Camper Name
Primary Parent/Guardian Name *
Primary Parent/Guardian Name
Primary Parent/Guardian Phone
Primary Parent/Guardian Phone
Secondary Parent/Guardian Name *
Secondary Parent/Guardian Name
Secondary Parent/Guardian Phone
Secondary Parent/Guardian Phone
Additional phone numbers, work extensions, email addresses, etc.
We permit sharing with parent approval
I permit my child to wear sunscreen at camp *
(the state requires that we get permission -please send your child with sunscreen if you would like them to wear it when we go out for lunch)
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone
Emergency Contact Phone
Your child will only be permitted to go home with the people listed on this form and will be checked in and out each day. In the case that you want your child to be able to walk home if you live downtown, be picked up by a sibling, etc please list your special requests here.
Every camper gets a Circus Culture t-shirt!
Before filling out this form, you should have signed up and paid via our FrontDesk system. If you have not, please do that first to ensure we still have spots open!
Immunization Records & Medical Report (physical) *
I have emailed immunization records AND a medical report (physical), or an exemption request letter, and a doctor's written order and information for any medication (prescription or O.T.C.) that my child may be taking during camp to circusclaire@gmail.com. Be sure to name the file with your child's full name. Do it now and select yes!