Summer 2017 KAMP Registration Form
  
  

Select Kamp Site:


Participant Information:

  






Gender









 
Mother's Information
  











 
Father's Information
  











 
Emergency Contact Information







Relationship to child:
     



 
I hereby authorize the person above to pick up the above named participant form Hartford Summer KAMP Program. Person mus be a minimum of 16 years of age. If there are any changes in these arrangements, I will privide a written notice. Parents/Guardians mus be included on this release.

Check to confim:


       
       


550 Main Street, Room 305
Hartford, Connecticut 06103
  
Website: dfcyr.hartford.gov