Camp Registration Form
Child’s name _______________________________ Date of birth _____________ Gender _____
Parents’ name(s) ____________________________________________________
Street ___________________________________________________________
City_____________________________ State________ Zip _________________
Phone (day) _______________________(evening) _________________(cell) _______________
E-mail __________________________________________________________________
Allergies, Medications, Conditions ______________________________________________
Camp Title ____________________________________ Date ___________ Cost $__________
Camp Title ____________________________________ Date ___________ Cost $__________
____ Check here to become a member at The Works for a full calendar year for only $55. ______
Total due with registration $___________
Method of payment: O Check (Please make checks payable to The Works.)
O Visa/Master Card #______________________________ exp._________
I authorize staff at The Works to give my child first aid and to transport my child by ambulance to a health care
facility if emergency medical treatment is needed.
Signature ____________________________________________________ Date _____________
Photographs: Registration implies permission to use photographs of students for promotional purposes only.
Children will not be identified by name. (If you prefer your child not be photographed, please cross this section out).
Please mail to: The Works 5701 Normandale Road Edina MN 55424
Please call 952-848-4848 if you have questions.