Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family and Information
First Name:* Last Name: *
Relationship to Student*
Home Phone:* Cell #: Work #:
Email:* (Emails are kept confidential)
Address: *
City: * State: * Zip: *
Who do we contact in case of an emergency (Name, Phone #, & relationship to student)?*
Students entered below will be added to your family's account
What dates do you want? Would you like AM (8:30-12:00), PM (1:00-4:30) or ALL day. Also, you want full week or single days. Please, be specific.*
What Camp theme would you like? *
What is your Credit Card Bill Address*
Was this Camp registration reservation completed while inside the GymStars Facility?*
Is the participating child a GymStars Stockton Member?*
What is your school & grade?
Emergency Contact- other than parent's*
Has your child attend Day Camps before?*
If your child were to appear in a photo or video taken at our functions are we free to use it for marketing and advertising?*
Please, list those adults to whom your child may be release to and picked up by. Photo ID will be required for anyone signing out your child.*
Please, list anyone who does NOT have permission to child up your child.
Please, list any friends your child would like to be placed with
Are there any GymStars classes that we need to take your child to during or after camp?*
If yes, please list Day, Time, Coach
Are there any medical conditions to which we should be alerted. If so, please list. If not, type "No"*
Any use of the following: (contacts, glasses, hearing aids, etc."? If so, please list. If not, type "No".*
Does your child have any medication allergies or sensitivities? If so, please list. If not, type "No".*
Is your allergic to anything? (example: Bee stings, peanuts, tree nuts, dairy, sun screen, etc) If so, please list. If not, type "No".
Will your child be taking any medications while at camp or need an inhaler or epi-pen?*
Is an epi-pen needed for any of the allergies listed? If so, please list. If not, type "No".
If you child will be taking any medications during camp hours, please list the Medicine, time dosage, if refrigeration is required and if there are any special instructions.
Is there anything that your child does not eat to which we should be alerted? If so, please list. If not, type "No".
Has your child been exposed to or had the following: Rheumatic Fever, Chicken Pox, Measles, Rubella, Mumps, COVID-19 or other? If so, please list. If not, type "No".*
Doctor's Name and Phone Number*
Dentist's Name and Phone Number*
Insurance Company and Policy #*
Parent or Legal Guardian Name*
Additional Information:
Other Questions/Comments:
Credit Card Verification:
Card Number: *  
Name as it appears on card: *
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*