SUMMER Camp-A-Thon 2021

SUMMER 2022
BOYS & GIRLS CLUBS OF ST. LUCIE COUNTY
Name*

Child's First NameChild's Last Name
Child's Age*
Weekly Payment: $85 per child
All children, regardless if they already attend a Boys & Girls Club during the school year, will need to fill out a 2022 membership form.

Please access the 2022 membership form below:
LOCATION
Which Camp Will Your Child Attend?*

Westside Club Summer Camp - 3361 S Jenkins Road, Fort Pierce, FL 34981MidFlorida Event Center Summer Camp - 9221 Civic Center Place, Port St. Lucie, FL 34952
SUMMER PROGRAM DATES

NOTE: we require 10% payment (about $8.50) for every week signed up
Check the weeks you desire for Summer Camp*

WK 1 (June 6-10)WK 2 (June 13-17)WK 3 (June 20-24)WK 4(June 27- July 1)WK 5 (July 5-8) Monday, July 4th we are closedWK 6 (July 11-15)WK 7 (July 18-22)WK 8 (July 25- 29)WK 9 (Aug 1-5)
YOUTH T-Shirt Size - Please Check ONE (Shirt size may not be guaranteed - depending on quantity)

SmallMediumLarge
ADULT T-Shirt Size - Please Check ONE (Shirt size may not be guaranteed - depending on quantity)

SmallMediumLargeExtra Large
NOTE: There will be no refunds or credits of any kind for unattended weeks, trips or behavioral removal.
Parent/Guardian Name (Please Print)*
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
Daytime Contact Phone Numbers*
BOYS & GIRLS CLUBS OF ST. LUCIE COUNTY

My son/daughter, (please print)
My son/daughter Name* , Age*
For the safety of your child. Does your child know how to swim?*

YesNo
Parent/Guardian's Name*
Parent/Guardian's Phone Number(s)*
Emergency Contact's Name*
Emergency Contact's Phone Number(s)*
Parent/Guardian's Signature*

Clear
Date Signed*

Clear
Should be Empty:

SUMMER 2022

Weekly Payment: $85 per child

LOCATION

SUMMER PROGRAM DATES

NOTE: There will be no refunds or credits of any kind for unattended weeks, trips or behavioral removal.