CDS Summer Camp Application (Voyagers - ages 6

CDS Summer Camp Application (Voyagers - ages 6 - 10 years)
Please use this form to sign up your campers who are 6 - 10 years old. If your child is younger, please select the Explorers (ages 3 to Kindergarten) or the Adventurers (18 mos. to 3 years) application forms.

Please fill in the required fields completely and select your registration options. This form does not collect any payment information. This form is an application for a spot at Chesterfield Day School's summer camp, and we cannot guarantee that a spot will be available for everyone who fills out this form.

Once a place at camp has been confirmed for your child, you will receive an emailed link to a secure payment portal where you will pay the amount due. The payment portal accepts all Visa, Mastercard, American Express, and Discover debit and credit cards. You will also be notified as early as possible if we are unable to give your child a place at camp.

Please contact us if you have any questions or difficulty with this application form.

Thank you, and we look forward to seeing your camper this summer!
By clicking the "Accept" button here, I acknowledge and accept that this form does not guarantee my child a spot at camp, but is an application for a place at camp. I further accept that a place is not guaranteed. *

Accept
Accepted
Child's First Name *
Child's Last Name *
Preferred Name
Gender *
Date of Birth *

Month Day Year
Date
Current School
Current Grade
Address *

Street Address

Street Address Line 2

City State

Zip Code
Parent / Guardian Information
Full Name *

First Name Last Name
Home Phone *
Please enter a valid phone number.
Cell Phone *
Please enter a valid phone number.
Work Phone
Please enter a valid phone number.
Email for Confirmation and Payment Link
example@example.com
Second Parent / Guardian *
Full Name (2)

First Name Last Name
Home Phone (2)
Please enter a valid phone number.
Cell Phone (2)
Please enter a valid phone number.
Work Phone (2)
Please enter a valid phone number.
Email (2)
example@example.com

Medical / Emergency Information
Pediatrician *

First Name Last Name
Pediatrician Phone *
Please enter a valid phone number.
Hospital Preference *
Emergency Contact *

First Name Last Name
Emergency Contact Relationship *
What is the Emergency Contact's Relationship with the Camper
Contact Phone Number *
Please enter the most likely to reach your contact.
Does the camper have any food allergies? *

Yes No
Allergy List and Procedures
Please list and describe the food allergies in detail. In particular, please describe their severity and whether or not the child will require an epi-pen at camp.
Does your child have any other health conditions?

Yes No
Health Conditions
Please describe any other health conditions in detail that may affect the child's experience at camp.
Does your child require any medication to be given during camp hours?

Yes No
Medication
Please provide detailed instructions for administering your child's medication - time and dosage, etc. Any prescription medication must be in its packaging from the pharmacy or accompanied by a doctor's note/prescription.

Medical Release

I hereby grant permission to Chesterfield Day School, the Fulton School, and their respective agents and employees to secure such medical aid and hospital services as they deem necessary for the child noted on this application in the event he/she should sustain an injury or illness while attending camp. I have also indicated above any medical information of which the camp should be aware in consideration of the child's physical and mental well-being.
By selecting Accept, I, the parent or legal guardian of the child noted on this application accept the terms of the medical release. *

Accept
Medical Release Signature - Please sign with mouse, trackpad, or mobile screen. *

Clear

Enrollment Information

Camp and Care Selection *

Voyagers - July Session (7/11 - 7/29) Please select your option for attendance.

Attendance Options	Quantity	Price
5 Full Days (M-F)		$ 1,050.00
Week 1 - Full Days		$ 400.00
Week 2 - Full Days		$ 400.00
Week 3 - Full Days		$ 400.00

Item subtotal: $ 0.00

Extended Day Care Please select the number of WEEKS that you will need extended day care.

Weeks	Quantity	Price
Extended Day - Before Camp - One Week		$ 50.00
Extended Day - After Camp - One Week		$ 100.00
Extended Day - Before and After Camp - One Week		$ 130.00

Item subtotal: $ 0.00

Enter coupon

Total

$ 0.00

Application Code
Should be Empty:

CDS Summer Camp Application (Voyagers - ages 6 - 10 years)

Parent / Guardian Information

Medical / Emergency Information

Enrollment Information