Register for Camp The Plain City Laffalot Summer Camp Registration Form Parent (Last, First): Camper (Last, First): Address: City,State,Zip: OH KY IN MI Mom Cell: Dad Cell: Emergency number: Contact Email (only one): School: Grade (2023-2024 school year): -Please Select- First Second Third Fourth Fifth Sixth Shirt Size: -Please Select- Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Weeks Attending: June 27-July1, 2022 After/Before Care : -Please Select- Yes No Camper Gender: -Please Select- Female Male Promotion Code: Physician's Name Physician's Phone Number Dentist's Name Dentist's Phone Number Medical Insurance Company Policy Number Please list Medical conditions you feel we should be aware of My child/ward may participate in all Program activities except I have read and agree to the Medical Release (Check box and sign full name) I have read and agree to the Release and Hold Harmless (Check box and sign full name)