Camper Personal Form

Child's Name :

*

Nickname :

Birthdate:

*

Gender:

Select Female Male

Grade (Next Sept):

Pre-K Kindergarten 1 2 3 4 5 6 7 8 9 10

School (Next Sept):

*

Preferred Phone#:

*

Parent E-mail address:

Camper E-mail address:

Camper T-shirt Size

Parent Status:

Select Married Divorced Separated Partnership Guardian

Mother Deceased:

Select Yes No

Does your child have any special needs- medical, emotional, or learning? Please give
detailed account.

What are your child’s favorite activities?

What would you like your child to accomplish this summer at Gate Hill?

Has your child had any past experiences (at camp or outside of camp) that make him/her
particularly happy or upset?

How would you describe your child’s swimming ability and attitude towards swimming?

Have any changes occurred in the recent past that might affect your child’s behavior?

Please share any additional information you think we should know.