Camp Fired
Summer - 2007

Bedford - Salem - Concord

Online Sign Up
Online Registration Instructions:

Fill out all info.  If you are submitting for two children, you will need to fill out two forms (but
total each at $85 per camp).

Visa or Mastercard Only for online registration.

We will mail your receipt to the address provided.
Select Studio
Location
Select Camps

Hold CTRL
button to choose
more than one.
Campers Name:
D.O.B.
 Home Phone:
Parents Name &
Home Address:
(for receipt
mailing)
Emergency Contact:
Phone:
Allergies/Medical Information: (List any and all)  :      
Medical Permission Info:
In case of an accident or serious illness, I request that the camp contact me.  If
they are unable to reach me, I authorize them to call the physician indicated
below and follow his/her instructions.  If it is impossible to contact the physician,
the camp may make whatever arrangements necessary to expedite medical
attention for my child.
Parents Name:
Date:
Type "yes"  to agree with the above
Physician Name:
 Phone:
Physician Address:
I understand that my child will be released to
his/her legal guardian only unless I inform the
staff otherwise. Type "Yes" in the box to the right:
Total Charges (One camp $95, two or more $85 each)
Master Card or Visa Number:
Exp Date:
 Name on Card:
Card Mailing Address Zip Code:
 
 
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