Wufoo

Camper Registration Form

Please complete all fields below and submit to register. Please make payments by clicking on the above "Buy Now" button or you can send payments by check to: Camp One Way, 1654 E 2945 N. Rd., Mt. Auburn, IL 62547. Feel free to call or email us with any questions or concerns you may have. 217-676-2533 or 800-500-6774 ~ camponeway@yahoo.com

Parent/Guardian Name * First Last
Camper's Name *
Camper's Current or Completed Grade *
Address *

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone * - (###) - ### ####
Emergency Phone * - (###) - ### ####
Email *
I give permission for my child to attend the Camp One Way (name of event): *
I give permission for: Camp One Way Employees to make Tylenol available for my child for headache Certified medical personnel to render emergency treatment for my child in case of an accident or illness Pictures of my child taken at this event to be used in Camp One Way Publicity
Other Comments or Allergies or medical conditions (Note: medicines brought to camp must contain prescription or written instructions from parent or guardian):
Do Not Fill This Out