POM - Bixby Pom Summer Camp

First Name *
Last Name *
Mobile *
Email *
Grade *
Birth Date *
Address *
City *
State *
Zip Code *
Medical Information *

List Medications/Medical Conditions here. If none, type N/A

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Guardian First Name *
Guardian Last Name *
Guardian Cell Phone *
Guardian Email *
Alternate Guardian First Name
Alternate Guardian Last Name
Alternate Guardian Phone
Alternate Guardian Email
Medical Release Information
By registering for this Camp, I agree to the following Waiver & Release of Liability: https://bixbyps.info/cewaiver
Guardian Signature *

I, the parent/legal guardian, agree entirely to the Medical Release Information.: clear
BPS employees receive a $15 discount. Please use your BPS email when registering for confirmation: BPS Employee [-$15.00]

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Bixby High School Dance (F)

Please take a moment to fill out the information below and then proceed to the next page.

$125.00

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CAMPER INFORMATION