Name_________________________
Age__________________________
Gender_______________________
School_______________________
Grade Completed________________
Health Card Number__________________
Birthday____ /____ /_______ (MM/DD/YYYY)


Friend to Bunk with _________________
Mothers number __________________
Fathers number __________________
Home number ______________________
Emergancy contact ___________________ number ____________
Realation to child __________________
Any allergies ____________________
Other _____________________