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PARENT OR GUARDIAN INTAKE FORM

Drop Details

SECTION 1
Camper Information:

Camper #1

First Name

Last Name

Camper age:

Camper gender:

Date of birth:

Anything you'd like us to know??

Camper #2

First Name

Last Name

Camper age:

Camper gender:

Date of birth:

Anything you'd like us to know??

Camper #3

First Name

Last Name

Camper age:

Camper gender:

Date of birth:

Anything you'd like us to know??

SECTION 2 Parent/Guardian Information:

Parent / Guardian info:

First Name

Last Name

Relationship to camper(s):

Date of birth:

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Email

Primary Phone

Secondary Phone

Time of drop off

02:30 PM

Date of drop off

SECTION 3
Authorized Pick-Up Person:

Time of estimated pick up

02:30 PM

Authorized Pick up person info:

Pick up Person #1

First Name

Last Name

Relationship to camper(s):

Phone

Pick up Person #2

First Name

Last Name

Relationship to camper(s):

Phone

SECTION 4 Emergency Contacts:

Emergency contact info:

Emergency contacts:

Authorized pick up person #1

Authorized pick up person #2

NEW - see below

Emergency contact #1

First Name

Last Name

Relationship to camper(s):

Phone

Emergency contact #2

First Name

Last Name

Relationship to camper(s):

Phone

SECTION 5
Medical Information:

- Allergies (food, medication, etc.):

- Medical Conditions:

- Medications (name, dosage, frequency):

- Primary Physician:

SECTION 6
Consent and Agreement:

I, the undersigned, hereby give permission for my child(ren), to participate in the Ground Zero Laser Tag Summer Camp. I understand that all activities will be supervised, but I agree that Ground Zero Laser Tag and its staff will not be held responsible for any accidents or injuries that may occur. I authorize the camp staff to obtain emergency medical treatment for my child if necessary. I also confirm that the above information is accurate and complete to the best of my knowledge.

I agree to the terms & conditions

**Signature of Parent/Guardian:

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Drop Details

SECTION 1
Camper Information:

Camper #1

Camper #2

Camper #3

SECTION 2

Parent/Guardian Information:

Parent / Guardian info:

SECTION 3
Authorized Pick-Up Person:

Authorized Pick up person info:

Pick up Person #1

Pick up Person #2

SECTION 4

Emergency Contacts:

Emergency contact info:

Emergency contact #1

Emergency contact #2

SECTION 5
Medical Information:

SECTION 6
Consent and Agreement:

Let's Go!

Drop Details

SECTION 1 **Camper Information:**

Camper #1

Camper #2

Camper #3

SECTION 2

**Parent/Guardian Information:**

Parent / Guardian info:

SECTION 3 **Authorized Pick-Up Person:**

Authorized Pick up person info:

Pick up Person #1

Pick up Person #2

SECTION 4

**Emergency Contacts:**

Emergency contact info:

Emergency contact #1

Emergency contact #2

SECTION 5 **Medical Information:**

SECTION 6 **Consent and Agreement:**

SECTION 1
Camper Information:

Parent/Guardian Information:

SECTION 3
Authorized Pick-Up Person:

Emergency Contacts:

SECTION 5
Medical Information:

SECTION 6
Consent and Agreement: