2020 Camper Info – Becker County Museum

Student First/Last Name *

Parent/Guardian First/Last Name *

Address *

City, State, Zip

EMail *

EMail If Different During Camp Time

Phone *

In case of emergency please contact: Name 1 *

Phone 1 *

In case of emergency please contact: Name 2

Phone2

In case of emergency please contact: Name 3

Phone 3

Emergency Options And Photos *

In Case of Emergency, I give consent to seek medical treatment

I give consent for my child’s picture to be taken and for the Becker County Museum to use for advertising and publications

My child will be :

attending another camp at the Historic Holmes Theatre or DLCCC and will need to be escorted.

picked up by:

Name Of Pickup Person