Camp Registration

Please fill out the form below for each child attending camp!

Camper Information

Camper Name

Date of Birth

Allergies / Medical Concerns

Prescribed Medications (Names, Dosage, Frequency)

Physician Name

Phone Number

Primary Insurance Name

Primary Insurance ID Number

Secondary Insurance Name

Secondary Insurance ID Number

Any addtional notes you want the ATA staff to know about your child?

Parent/Guardian

Phone Number

Parent/Guardian

Phone Number

Contact Name

Phone Number

Contact Name

Phone Number

Contact Name

Phone Number