Lee County Parks and Recreation 2025
Summer Camp Participant Supplemental Form

Please complete all fields for your camper. This form must be completed and submitted to the camp site prior to the first day of camp.

Child 1 First Name

Child 1 Last Name

Child 1 DOB

mm/dd/yyyy

Does your camper know how to swim?

Yes

If other, please describe

Is your camper taking or in need of any medications? If yes, additional forms are required.

Yes

Camper is permitted to walk home. MIDDLE SCHOOL CAMP ONLY

Yes

Do you have any additional campers/siblings attending camp at the same camp location?

Please select the number of additional camper(s)

Check here if you are requesting program accomodation, modification or inclusion services for your camper(s) and you will be contacted by the ADA Supervisor.

Camper(s) Full Mailing Address

Camp Location

Please select all camp locations your camper(s) will be attending this summer.

Participant Behavior Contract

Please review the following with your camper(s). These rules apply to all registered camper(s) on this form entry.

I will follow the rules daily, including when on field trips and special activities:

1. I will participate in ALL activities and I will follow instructions of all program staff.

2. I will be polite and conduct myself in a respectful manner.

3. I will use appropriate language and I will not fight or verbally abuse another person.

4. I will use vehicle seatbelts whenever provided.

5. I will dress appropriately (no provocative or indiscreet dress) and wear closed toe shoes.

6. No personal electronic device use during camp hours unless approved.

Check the box below to acknowledge this information.

Emergency Contact Information

Parent/Guardian 1

Parent/Guardian 1 Daytime Phone

Phone

Parent/Guardian 1 Alternate Phone

Phone

Relation to Camper

Parent/Guardian 2

Parent/Guardian 2 Daytime Phone

Phone

Parent/Guardian 2 Alternate Phone

Phone

Parent/Guardian Relation 2

Parent/Guardian Email Addresses

Please provide email addresses for all parent/guardians. Camp announcements and communications will be shared via email. Please seperate email addresses with a comma.

Authorized Pick Up List

Please list other persons authorized to pick up camper(s), in addition to the Parent/Guardians listed above.

Name

Relation to camper(s)

Phone

Name

Relation to camper(s)

Phone

Name

Relation to camper(s)

Phone

Name

Relation to camper(s)

Phone

Name

Relation to camper(s)

Phone

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Lee County Parks and Recreation 2025Summer Camp Participant Supplemental Form

Emergency Contact Information

Authorized Pick Up List

Lee County Parks and Recreation 2025
Summer Camp Participant Supplemental Form