This form must be completed by a parent and by your pediatrician.

Please return the form to us as soon as possible - no later than June 1.

Return the form to us in one of these ways:

• Scan and email us at kimskidscamp@gmail.com
• Fax the form to (718) 788-3214
• Mail the form to us at 378 3rd Street, Brooklyn NY 11215
• Scan and upload the form using the button below (make sure file is in .pdf format)