General Info

Camper’s First Name (Required)

Camper’s Last Name (Required)

Date of Birth (Required)
Day / Month / Year
/ /

Father’s Name (Required)

Mother’s Name (Required)

Season

Choose camping season (Required)
A' PERIOD 17 JUNE - 1 JULYD' PERIOD 29 JULY - 12 AUGUSTE' PERIOD 12 AUGUST- 26 AUGUST

Departure from:
---UnknownParents ResponsibilityAlexandroupoliChrysoupoliDidymoteichoDramaFeresKavalaKeramotiKomotiniOreokastroOrestiasSoufliThessalonikiXanthi

Return to:
---UnknownParents ResponsibilityAlexandroupoliChrysoupoliDidymoteichoDramaFeresKavalaKeramotiKomotiniOreokastroOrestiasSoufliThessalonikiXanthi

Contact Info

Address (Required)

No. (Required)

City (Required)

Zip Code (Required)

Country (Required)

Land Phone (Required)

Work Phone

Father’s Mobile (Required)

Mother’s Mobile (Required)

Other Phone Number

Email (Required)

Have you ever visited Pitsas Camp? (Required)
YesNo

Indicate any additional information you consider relevant:

Health condition

Weight: (Required)

Childhood Diseases:
MeaslesRubellaScarlet feverMumpsChickenpoxPertussis

Any recent tetanus vaccination? (Required)
YesNo

Any allergies? (Required)
YesNo

Any allergies to medication? (Required)
YesNo

Any breathing problems? (Required)
YesNo

Any particular problems? (e.g. Nocturnal enuresis, Sleepwalking, Phobias)? (Required)
YesNo

Does it do gymnastics at school? (Required)
YesNo

Indicate any additional information you consider useful for our doctor:

Parent / Guardian Declaration to G. PITSAS CAMP LTD (Required)

(Required)
I therefore declare by electronically submitting this statement that I am legally exercising parental care of aforementioned minor.

I confirm the accuracy of the data provided and confirm that I have provided all the details concerning the health of my child.

For any information that might not have been expressly requested, I take the responsibility to communicated it to G. PITSAS CAMP LTD by any appropriate means.

(Required)
I responsibly declare that I am committed to my child's stay throughout the agreed period. Considering any alteration, please contact the camp as soon as possible.

The declarant (Required):

NAME*

SURNAME*

Taxpayer Identification Number (TIN) *

STATUS *
FATHERMOTHERGUARDIAN (Parental responsibility)

Do the math: 4 + 5

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