Camp Kupono

CAMP APPLICATION

CAMP

CAMP APPLICATION

CAMP

CAMP APPLICATION

APPLICATION

Complete and submit your camp application form here, or download the PDF below and bring on registration day.

Application Form

Application

Pay Now

* indicates required field

Camper Information

First & Last Name *

Gender *

Age *

Birthdate *

Camp Week *

T-shirt Size *

Home Address:

Line 1 *

Line 2

City *

State *

Zip *

Camper Phone Number (if applicable):

Roommate Request (optional):

I would like to room with… (one choice only, with both campers requesting each other)

First & Last Name *

I have read the general information section in this brochure, and I agree to comply with the dress and conduct regulations while at camp. *

Camper Signature:

Signature *

Date *

Parent/Guardian Signature:

Signature *

Date *

Other Notes:

Payment Method *

Online

Registration Day

Pay Now

How did you hear about Camp Kupono? *

Informed Consent *

I give consent for my child’s voice/likeness to be used non-exclusively, and royalty-free for advertisement and promotional purposes by Camp Kupono.

Medical Information *

My child may receive the following medications at the discretion of the camp nurse.

Allergies: Benadryl (Diphenhydramine)

Anti-itch: Ivarest, Caladryl, Hydrocortisone cream, Campho Phenique, Lavender Oil

Decongestant: Sudafed, Peppermint Oil (aromatic)

Indigestion: Mylanta

Pain/fever: Tylenol (Acetaminophen), Advil (Ibuprofen)

Sunblocks/sun burn relief: Lavender Oil, Aloe

Topical Antibiotics: Triple Antibiotic Ointment

List any exceptions here:

In case of medical emergency, I understand every effort will be made to contact parents or guardians of the camper. In the event they cannot be reached, I hearby give permission to the physician selected by the camp to hospitalize and secure proper treatment (i.e. injections, anesthesia, surgery, etc.) for my child named on the application. I agree to the release of any records necessary for treatment, referrals, billing, and insurance purposes. I also affirm that the medical information on this form is complete and correct. *

Parent/Guardian Contact:

First & Last Name *

Phone Number *

Email *

Emergency Contact Other Than Parent:

First & Last Name *

Phone Number *

List the FULL NAME and CONTACT of all other people who are allowed to drop off/pick up your camper:

Parent/Guardian Signature:

Signature *

Date *

Other Notes:

Payment Method *

Online

Registration Day

Pay Now

Waiver Form *

Please use autofill or print and scan this waiver to attach a completed PDF copy below.

Download Waiver

Waiver

Click or drag and drop to upload. Max 25 MB

Payment Method *

Online

Registration Day

Pay Now

Waiver Form *

Please use autofill or print and scan this waiver to attach a completed PDF copy below.

Waiver

Click to upload. Max 25 MB