Child's Information

Date of Birth

Desired Sessions

If your child requires bus transportation to and from camp, please provide contact and pick up/drop off information below.

If you have any comments on your child (e.g. particular areas of interest, behavior patterns) that would help make "Camp Smile" more enjoyable, please indicate them below.


Emergency Contacts

Please give the information at least one emergency contact.


Parents/Guardians

Please give the information at least one parent/guardian.