2021 Summer Camp Registration Form

AGES 6-12

DAY CAMP COST
$100 WEEKLY FOR FULL DAY CAMP ALL FIELD TRIP COSTS INCLUDED

NO REFUNDS OR CREDITS FOR DAYS NOT ATTENDED.

MORNINGS ONLY 8:30AM-12:30PM $50 WEEKLY

$25 DAILY DROP IN FEE PLUS FIELD TRIP COSTS.
REQUEST AND APPROVAL THROUGH THE GENERAL MANAGER ONLY

Childs Name *

First Name Last Name

Birth Date *

Month Day Year

Grade *

Gender *

Male Female

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Short Medical # *

Long Medical # *

Parent/Guardian Information

Name *

First Name Last Name

Home Number *

Area Code Phone Number

Cell Number *

Area Code Phone Number

E-mail *

Camp Weeks *

Week 1 July 5-9 Week 2 July 12-16 Week 3 July 19-23 Week 4 July 26-30 Week 5 Aug 3-6 (short week ) Week 6 Aug 9-13 Week 7 Aug 16-20 Week 8 Aug 23-27 Week 9 Aug 30-Sept 3

Emergency Information

Emergency Contact's Name ( not guardian) *

First Name Last Name

Phone Number *

Area Code Phone Number

Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe.

Behavior Concerns including triggers and any special emotions. Every bit helps make your childs camp experience a better one

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

E-mail