2022 WMACS Summer Camp Registration

Parent 1 Name *

First

Last

中文姓名 *

Phone Number *

Email *

Parent 2 Name

First

Last

中文姓名

Phone Number

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Insurance Company *

Policy *

Group ID

Member ID *

Doctor Name *

Doctor Phone Number *

Emergency Contact Name *

Emergency Contact Relation to Camper *

Emergency Contact Phone Number *

Were you referred by someone? If so, please write the camper's name below! *

First

Last

Total Campers *

1 Camper
2 Campers
3 Campers

Camper #1 Name *

First

Last

Camper #1 中文姓名 *

Camper #1 Email

Camper #1 Gender *

Camper #1 Pronouns *

Ex: she/her, he/him, they/them, etc. For more information, please visit mypronouns.org/what-and-why AND mypronouns.org/how

Camper #1 Roommate Request

Camper #1 US School *

Camper #1 Grade *

Camper #1 中文學/学校 Chinese School

Camper #1 年級/级 Chinese School Grade

Camper #1 Allergy

Camper #1 Medication

Camper #1 Physical Limitations

Camper #1 T-shirt Size *

Camper #1 Photo *

Camper #2 Name

First

Last

Camper #2 中文姓名

Camper #2 Email

Camper #2 Gender

Camper #2 Pronouns

Ex: she/her, he/him, they/them, etc. For more information, please visit mypronouns.org/what-and-why AND mypronouns.org/how

Camper #2 Roommate Request

Camper #2 US School

Camper #2 Grade

Camper #2 中文學/学校 Chinese School

Camper #2 年級/级 Chinese School Grade

Camper #2 Allergy

Camper #2 Medication

Camper #2 Physical Limitations

Camper #2 T-shirt Size

Camper #2 Photo

Camper #3 Name

First

Last

Camper #3 中文姓名

Camper #3 Email

Camper #3 Gender

Camper #3 Pronouns

Ex: she/her, he/him, they/them, etc. For more information, please visit mypronouns.org/what-and-why AND mypronouns.org/how

Camper #3 Roommate Request

Camper #3 US School

Camper #3 Grade

Camper #3 中文學/学校 Chinese School

Camper #3 年級/级 Chinese School Grade

Camper #3 Allergy

Camper #3 Medication

Camper #3 Physical Limitations

Camper #3 T-shirt Size

Camper #3 Photo

Signature *