Contact Information & Medical Form

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Parent or Guardian's First Name(required)

Parent or Guardian's Last Name(required)

Child's First Name (required)

Child's Last Name (required)

Age of Child on First Day of Camp(required)

Preferred Medical Facility Name (required)

What T-Shirt Size Does Your Child Wear? (child medium, child large, adult small, adult medium, adult large)(required)

Please list your child's allergies. (If none, write N/A) (If your child as specific food allergies feel free to send a separate snack.) Please list an email address so that we may send camp information or updates. (required)

Please describe your child's allergic reaction (If none , write N/A)(required)

Are there any other medical concerns that we should be aware of?(required)

Is your child on any medications?(required)

Please provide the name, relation to the child, and phone numbers of caregivers who may be picking up or dropping off your child. (Example: John Smith, Uncle, 555-222-1111. ) Note: If someone, other than those listed needs to pick up your child please call this number (409) 220-3021 before the time to pick up and let us know the name of that individual. Please list up to four names. (required)

Is there any other information that you would like for us to know?(required)

Please list an email address that we may send camp information or updates. (required)

The electronic submission of this form gives permission to use all photos and videos taken during programs for promotional purposes. If you would like to opt out of this, please email summercamp@thebryanmuseum.org to opt out of use of images for marketing purposes.