Summer Camp 2023 Registration/Payment Form

Summer Camp Registration Form & Payment

In-Person Summer Camp 2023
CAMPER'S INFORMATION

Please fill in all required fields
Campers Name *

First NameLast Name
Preferred Pronouns (N/A if you prefer not to answer)*
She/Her, Him/He, They/Them etc.
Campers Birth Date*

MonthDayYear
Date
School they attend
Will a sibling be joining camp?

YESNO
Sibling Information

Please fill in all required fields
Siblings Name *

First NameLast Name
Preferred Pronouns (N/A if you choose not to answer)
She/Her, Him/He, They/Them etc.
Siblings Birth Date*

MonthDayYear
Date
Will another sibling be joining camp?

YESNO
Siblings Name *

First NameLast Name
Preferred Pronouns (N/A if you choose not to answer)
She/Her, Him/He, They/Them etc.
Siblings Birth Date*

MonthDayYear
Date
Will the siblings be joining all the same camp weeks?*

YESNO
List each week siblings will join together
PARENT/GUARDIAN INFORMATION

You must fill out all sections below
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email*
example@example.com
Main Phone Number*
Cell phone preferred
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Information

Please fill in all required fields
Name*

First NameLast Name
Phone Number*
Cell phones are preferred
Email*
example@example.com
Medical Information

Please fill in all required fields
Health Care Provider*
Health Care & Group Number*

member number Group number

Summer Camp Weeks - TO ADD CAMP TO CART CHECK UPPER LEFT-HAND CORNER, THEN CHOOSE QUANTITY CHECK TOTAL BEFORE SUBMITTING*

NEO-POP ART | 3 DAY CAMP: 9/4 - 9/6 Product Image

NEO-POP ART | 3 DAY CAMP: 9/4 - 9/6 Camp time 9 am - 4 pm | Monday and Wednesday has a few spots available

$135.00

camp options	Quantity	Price
MONDAY 9/4		$135.00
WEDNESDAY 9/6		$135.00

Early Drop Off | 8am | DAILY Product Image

Early Drop Off | 8am | DAILYEarly Drop Off Daily 8 am Option. Please specify below which day/days are needed in a full week of camp.

$20.00 Quantity

Extended Day | 5pm | DAILY Product Image

Extended Day | 5pm | DAILYExtended Day 5 pm Daily Option. Please specify below which day/days are needed in a full week of camp.

$20.00 Quantity

Early Drop Off | 8am | WEEKLY Product Image

Early Drop Off | 8am | WEEKLYThis is a full week of Early Drop Off 8am

$80.00 Quantity

EXTENDED DAY 5 pm | WEEKLY Product Image

EXTENDED DAY 5 pm | WEEKLYThis is a full week of Extended Day 5 pm

$80.00 Quantity

Enter coupon

Total

$0.00

Please list any ALLERGIES and or any health/non-health related information we should know about your child
The more information you can provide regarding any additional needs your child may have, the better are able to support them in the classroom.
STOP DID YOU APPLY SIBLING COUPON CODE SBLING
PLEASE READ ALL INFORMATION BELOW BEFORE SUBMITTING FORM
Student Vaccination Card - If your child is vaccinated we are asking to have the card on file for class. You can upload it below or email it to rene@createdbykidsnyc.com.

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PLEASE DOWNLOAD THIS FORM BEFORE SUBMITTING REGISTRATION
Student HEALTH FORM - If your child's has visited the Dr within the last 12 months and you have their health form ready for camp you can upload it here. If you do not have this on hand you can email it to us as soon as you do.

HEALTH FORM
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You must read though all our Terms & Conditions before signing below - PLEASE NOTE WE DO NOT OFFER REFUNDS DUE TO CANCELATIONS FOR ANY REASON. BY SIGNING BELOW YOU AGREE TO ALL THE TERMS LISTED -
IF YOU REQUEST A REVERSAL OR REFUND DUE TO A MISTAKE MADE ON YOUR FORM (SUCH AS BUT NOT LIMITED TO FAILURE TO APPLY THE SIBLING DISCOUNT CODE, CHOOSING THE INCORRECT QUANTITY OR CAMP WEEKS) YOU WILL STILL BE CHARGED THE SERVICE FEE AS PAYPAL DOE NOT REFUND THIS FOR ANY REASON. PLEASE BE SURE TO CHECK THAT YOUR FORM AND TOTAL ARE CORRECT BEFORE MAKING PAYMENT.
DO NOT SUBMIT FORM TWICE - EMAIL US IF FORM HAS ERROR AFTER YOU SUBMIT

RENE@CREATEDBYKIDSNYC.COM
By signing below you have read to and agreed to our Terms & Conditions and Paypal Fees

Clear
Date Signed

Payment Methods

Debit or Credit Card

First Name

Last Name

Credit Card Number

Security Code

Card Expiration

Please click one of the PayPal options to complete payment and submit the form.

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Summer Camp Registration Form & Payment

CAMPER'S INFORMATION

Sibling Information

PARENT/GUARDIAN INFORMATION

Emergency Contact Information

Medical Information

DO NOT SUBMIT FORM TWICE - EMAIL US IF FORM HAS ERROR AFTER YOU SUBMIT