UPDATE EMERGENCY
CONTACT FORM
Camper’s Name:________________________________________________________ Date of Birth:_____________________________
Camper’s Home
Address:___________________________________________________________________________
___________________________________________________________________________
Parent / Guardian Information:
Father’s Name:__________________________________________________ Phone:___________________________
Address:___________________________________________________________________________________________
Father’s Work:_____________________________________________ Phone:______________________ Cell #:___________________
Mother’s Name:_________________________________________________ Phone:_________________________
Address:___________________________________________________________________________________________
Mother’s
Work:_____________________________________________
Phone:______________________ Cell #:___________________
Pick Up
Persons authorized to pick up camper:
1. Name:_________________________________________________________ Phone:________________________
2. Name:_________________________________________________________ Phone:________________________
3. Name:_________________________________________________________ Phone:________________________
In case of an emergency
notify:____________________________________________
Phone:_________________
Check here if there are any changes from the original emergency contact form
that is on file in the office.
