Camp Pineview

Summer Adventure Registration Form

1. Camper Details

First Name *

Last Name *

Date of Birth *

Age at Camp Start *

Gender

T-Shirt Size *

Parent First Name *

Parent Last Name *

Email Address *

Primary Phone *

Home Address *

Select Session(s) *

Week 1: June 1-7

Week 2: June 8-14

Week 3: June 15-21

Full Month

Cabin Preference

Buddy Request (Optional)

Camper's Swimming Ability *

Non-Swimmer Needs shallow water only

Beginner Can swim basic strokes

Advanced Comfortable in deep water

Primary Physician Name *

Insurance Provider & Policy # *

Allergies (Food, Environmental, Medication) *

Current Medications

Dietary Restrictions

Vegetarian Vegan Gluten-Free

Emergency Contact Name *

Emergency Phone *

Relationship to Camper *

Medical Release Consent * In the event of an emergency, I authorize camp personnel to secure medical treatment for my child.

Photo & Video Release * I grant permission for my child to be photographed/recorded for camp newsletters and promotional materials.