Camp Application;

 Camper's Name:_________________________

 Address:_______________________________

 ______________________________________

 Parents Name:__________________________

 Home Phone:___________________________

Cell P{hone:_____________________________

 E-Mail:_________________________________

Emergency Contact # _____________________

 ______________________________________

 I  authorize Camp- Cuff ,  Director's or their designed representaive to act on my behalf  to authorizung emeergency medical  , dental or surgical care and hospitalization for the above name minor duting the period of my absence. This document will be presented  will be presented to a physician or dentist or appropriate hospital representative at such time as necessary.

Parents Signature: ________________________

Date ________________

 If your child requires any medication while at Camp_Cuff  Please call the office for medical authorization.

Please list all Medication.

  ______________________________________

  _____________________________________

  ______________________________________

Refer all questions To

Katherine Cuff, Bruce Cuff

or Eric Willis Sr. at the  phone number's below or

 E-mail

cuffkatherine@yahoo.com

Office: 215-690-4742

Cell Ph: 215-837-5609

215-219-8934

215-908-9249