Youth Information Form (Ages 0-17)

We’re so excited for you to come to Michigania this summer! Thank you for taking the time to provide this information to us in advance. If you have any questions or anything changes after you submit this form, please email michigania@umich.edu. This form is for all Michigania participants ages 0-17.

Thanks again! We’ll see you soon.

Application ID

Contact Information

Emergency Contact #1 Name

Cell Phone Number

Emergency Contact #2 Name

Cell Phone Number

List any additional people and contact information you'd like to include for staff.

Approved Camp Session

Child/Teen Information

CamperContactID

CamperID

Child/Teen's Full Name

Child/Teen's Nickname or Preferred Name

Relationship to Emergency Contact

Child/Teen's Date of Birth

Age/Grade of Child in Upcoming School Year

Describe any medical conditions or health needs that staff need to be aware of.

Michigania staff do not administer medication.

List any instructions or information that will help the staff who will be working with your child/teen.

Acknowledgement

I hereby certify the information shared in this form is true and I have given the Michigania staff sufficient information to be able to provide the best care possible for my child/teen.

I agree

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