Camp Forest 60 Payson Road ~ Brooks, ME ~ 04921 ~ (207) 722-3708 ~ 1-888-760-7943 Please print, complete and mail or your registration form. 2010 Camper Registration Form Camper Name: Age: DOB: Gender: Parent/Legal Guardian Name(s): Address: City: State: Zip: Home Phone: ( ) Work Phone: ( ) Email Address: Emergency Contact: Emergency Phone: ( ) Check Weeks Desired - $150.00 per week - $175.00 day camp with sleep over. June 28 - July 2 -July 4 parade July 5 - July 9 with optional Sleep Over July 12 - July 16 July 19 - July 23 with optional Sleep Over July 26 - July 30 August 2 - August 6 with optional Sleep Over August 9 - August 13 August 16 - August 20 Is there anything physical, mental, or emotional about your child we should know? Is there anything in particular you would like us to know about your child? Medical Information: Please bring a copy of child's up-to-date immunization record. Date of Last Tetanus Shot: ____________________ Does child have: ____Heart Trouble ____Epilepsy ____Asthma ____Allergies Does child take medications regularly? ____Yes ____No If so, please list: _____________________________________________________________ Insurance Name:______________________________ Number:________________________ Doctor's Name: ____________________________ Telephone: __________________________ Please complete and mail with your $25.00 non-refundable registration fee. ____Check/Money Order Enclosed ____MC/Visa #___________________ Ex Date__________   Permission form will be mailed to you.   We look forward to seeing you at camp!