Elks Kids Week Registration Alexandria

Elks Kids Week Registration - Alexandria Lodge

Please complete the information below and hit Continue.

* Indicates required field

Which Lodge is the Sponsoring Elk From: *

Name Of Sponsoring Elk Member *

Which Session? *

Child's Gender *

Male Female

Child's Age (at time of camp) *

Child's First & Last Name *

Please identify any other children you would like as cabin mates *

Street Address *

City *

State *

Zip *

Parent or Guardian First & Last Name *

Relationship *

Home Phone # (if no home #, use cell #) *

Relationship *

Primary Email Address *

Cell Phone # (if no cell, use home or work) *

Has your child been away from home for longer than 2 days previously: *

Yes No

Work/Alternate Phone # *

Is your child a first time attendee or returning camper: *

First time camper Returning camper

Please describe any medical conditions, treatments or medications *

Is there anything else we need to know about your child *

Submit