Summer @ Sykes Camp 2013

Join the Fun at West Chester University


Summer @ Sykes

Parent Information

Parent First Name: Parent Last Name:
   
Home Phone: Email Address:
-  -   
WCU Employee: Confirm Email Address:
   
Home Address City State Zip
     
Emergency Contact Name #1: Emergency Contact Number #1:
  -  -   
Emergency Contact Name #2: Emergency Contact Number #2:
  -  -   
Number of Children Attending:
 
How did you hear about our program?
 
I authorize emergency care through 911 number and University Health Center for WCU Programs:
  Medical Release Consent (DOC)
I give Summer @ Sykes permission to use photos and video of my children for publicity: