Florida State University Seal

Environmental Health & Safety

 

Camp Insurance Request


Marked fields are required.


Basic Information

Camp Name:
Camp Begin Date:
Camp End Date:
Will the camp be overnight? No Yes


Contact Information

Name:
Phone:
Email:


Financial Contact Information

Department Name:
Name:
Phone:
Email:


Funding Information
Dept ID
Fund ID
Proj ID
CF 1
CF2

Campers

First Name: Last Name: Age:

Camper List:


Chaperones

First Name: Last Name:

Camper List:


Comments: