Summer 2017 KAMP Registration Form

Select Kamp Site:

Participant Information:



Mother's Information

Father's Information

Emergency Contact Information

Relationship to child:

I hereby authorize the person above to pick up the above named participant form Hartford Summer KAMP Program. Person mus be a minimum of 16 years of age. If there are any changes in these arrangements, I will privide a written notice. Parents/Guardians mus be included on this release.

Check to confim:


550 Main Street, Room 305
Hartford, Connecticut 06103