Camp 512 Registration Form

Camp 512 Registration
Camp 512 Registration & Payment Policies:

Upon completion of registration, you will be emailed a confirmation and payment receipt. There is a non-refundable $100 per camper/per session deposit for Summer Camp and a $25 deposit per camper/per day for Drop-In Days that will be applied towards your overall balance. If deposit payment is not completed within 48 hours of being sent, the campers spot will be forfeited. Payment is due 7 days before camp date. If payment is not received in full, the campers reservation will be cancelled.
Thank you! We are looking forward to a fun and exciting week exploring Austin and surrounding areas together!
-Camp 512 Directors

I have read and understand the Registration and Payment procedures.*
Yes
Camper #1 Information
Camper's Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade*
Pronouns*
If "Other," feel free to specify below:
First-Time Camper*

YesNo
Does the camper have any allergies, special needs, or medical conditions? If yes, please describe.*
Please list any medications the camper takes during the camp day.*

Camper #2 Information
Camper #2 Information
Camper's Name

First NameLast Name
Birth Date

MonthDayYear
Grade
Pronouns
If "Other," feel free to specify below:
First-Time Camper

YesNo
Does the camper have any allergies, special needs, or medical conditions? If yes, please describe.
Please list any medications the camper takes during the camp day.

Camper #3 Information
Camper #3 Information
Camper's Name

First NameLast Name
Birth Date

MonthDayYear
Grade
Pronouns
If "Other," feel free to specify below:
First-Time Camper

YesNo
Does the camper have any allergies, special needs, or medical conditions? If yes, please describe.
Please list any medications the camper takes during the camp day.

SEND A KID TO CAMP! This year, we'd love to offer camp scholarships-because camp is for EVERYONE! Please consider making a donation (of ANY size). Thank you!

Sure, glad to help! Not this time, but great idea!

I pledge to donate: Number

We appreciate your generosity! We will reach out directly to complete your payment.

Parent/Guardian Information
Name*

First NameLast Name
Home Number*
Cell Number
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Where is your preferred Drop-off/Pick-Up location for SUMMER camp? (Adventure Days will just be located at Westbank.)

Laura Bush Community Library: 9411 Bee Cave Road, 78733Westbank Community Library: 1309 Westbank Dr, 78746
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Alt. Phone Number
Primary Care Physician *

First NameLast Name
Primary Care Physician Phone*
Any other information you would like the Camp 512 staff to know?