CIT Registration - Belleville Sportsplex

Register as a Camp Counselor In Training

Your Name

Your Phone

Your Cell Phone

Your Email

Address

City

State

Zip Code

Child Name

Child Birthdate

Child Gender

Child School

Dr. Name

Dr. Phone

Emergency Contact 1 Name

Emergency Contact 1 Phone

Emergency Contact 2 Name

Emergency Contact 2 Phone

Other Parent Name

Other Parent Phone

Any Allergies or Medications

Pickup Name 1

Pickup Phone #

Pickup Name 2

Pickup Name 3

Anything else we need to know?

How were you referred?