Skip to content
Home
About Us
Services
Camp Peach Tree
R.O.O.T.S
Events
Newsletter
Contact
Peach Tree Advocacy
Registration
Home
About Us
Services
Camp Peach Tree
R.O.O.T.S
Events
Newsletter
Contact
← Back
Thank you for your response. ✨
Parent Name
Full Name
(required)
Camper Date of Birth (YYYY-MM-DD)
(required)
Age
(required)
Gender
(required)
Select one option
Male
Female
Other
T-Shirt Size (Child/Adult)
(required)
Select one option
Child XS
Child S
Child M
Child L
Child XL
Adult XS
Adult S
Adult M
Adult L
Adult XL
Address
(required)
City
(required)
State
(required)
Zip Code
(required)
Phone Number
(required)
Email Address
(required)
Parent/Guardian Full Name
(required)
Relationship to Camper
(required)
Emergency Contact #1 (Phone Number)
(required)
Relationship to Camper (Contact #1)
(required)
Emergency Contact #2 (Name)
Emergency Contact #2 (Phone Number)
Relationship to Camper (Contact #2)
Primary Care Physician
Physician Phone Number
Health Insurance Provider
Policy Number
Does the camper have any medical conditions or require medication?
(required)
Yes
No
If yes, please explain
Emergency Medical Treatment Consent
(required)
Yes
No
Preferred Hospital
Does the camper have any allergies?
(required)
Yes
No
If yes, please list all allergies
Does the camper carry an EpiPen or other emergency medication for allergies?
(required)
Yes
No
If yes, please provide instructions on its use
Transportation Consent (Adult volunteers for fieldtrips)
(required)
Yes
No
Picture/Video Consent
(required)
Yes
No
Digital Signature of Parent/Guardian
(required)
Date (YYYY-MM-DD)
(required)
Payment information:
https://www.paypal.com/ncp/payment/36LD5PRZAS844
(Debit, Credit, Venmo)
Submit
Submitting form
Δ
