​Roseland Junior Summer Camp Registration Form
 
Child(s) Name: ______________________________
Parent’s Name: ______________________________
Email: ______________________________________
Emergency Contact: ___________________________
Emergency Contact Number: _____________________
 
Who is responsible for picking up your child(s):____________________________________
 
__________________________________________________
 
Payment:
Cash______
Check___________
Credit Card_______
 
Date:_______________               Initial:___________