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Bring_a_Friend_Friday

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					                                   Camper’s Name: __________________________________

          Age:_____________ ( camp is open to ages 5yrs- 13yrs)
Bring your friend to bay camp on Fridays to Eastern Shore Bay Camp held
          Address:________________________________________
                                  at the K-1 Center in Fairhope
          City:_________________ State:______________ Zip:_________

                                            251-752-3890
          Mother’s Name:_____________________________DR LIC#__________________

Camper’s Name: __________________________________Age:_____________ ( camp is open to ages 5yrs- 12yrs)
         Mother’s Phone:_____________________Mother’s Work Phone:____

 Address:________________________________________City:_________________ State:______________
Zip:_________Mother’s Name:_____________________________DR LIC#_________________________

Mother’s Phone:_____________________Mother’s Work Phone:_________________________________

Father’s Name:______________________________DR LIC#_______________________________________

Father’s Phone:______________________Father’s Work Phone:___________________________________

Emergency Contact, Other than parents:_____________________________________________________

Emergency Contact Phone:________________________________________________ __________________

Person for Pick Up Authorization:_______________________Relationship:________________________

Insurance Company:______________Policy Holder:_____________I.D. #___________________________

                                RATES: $35.00 per child per day
   I give my permission for my son/daughter ___________________________ to participate in swimming, field
trips, and all other activities related to the Eastern Shore Bay Camp program. In case of emergency, I give
 permission to Eastern Shore Bay Camp to secure needed medical treatment for my son/daughter. I also
                             Release and Hold Harmless Eastern Shore Bay Camp

                    _________________________________________     ____________________________

                                            Parents Signature Date

***Please note: There is a $5.00 late fee for every fifteen minutes you are late picking up your child from
our program. Children must register for the entire week, daily rates are not available. Once you have pre-
registered you are responsible for payment in full . Payments are Non Refundable or Transferable. (i.e.
NSFs/ $30.00, Stop Payments will NOT be honored .)

   ***Registration Forms Avail. at: Eastern Shore Bay Camp or online or www.easternshorebaycamp.com

				
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