Camp Forest 84 Payson Road ~ Brooks, ME ~ 04921 ~ (207) 722-3708 ~ 1-888-760-7943 2008 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 - $125.00 first week - $115.00 each additional week June 23 - June 27 June 30 - July 4 July 7 - July 11 July 14 - July 18 July 21 - July 25 July 28 - August 1 August 4 - August 8 August 11 - August 15 August 18 - August 22 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!