SmARTen Up! Summer Camp Registration

Parent/Guardian Information
Parent/Guardian #1 Name *

First Name Last Name
Cell Phone Number *
Please enter a valid phone number.
Email *
example@example.com
Parent/Guardian #2 Name

First Name Last Name
Cell Phone Number
Please enter a valid phone number.
Email
example@example.com
Primary Address
Camper(s) Primarily Resides With *

Parent/Guardian #1 Both Parent/Guardian #2 Other
Address *

Street Address

Street Line 2

City State

Zip Code

Transportation & Emergency Contacts
Please list the name(s) of any individual(s), in addition to parents/guardians listed above, who are cleared to transport your camper(s) to and from camp and whom we may contact in the event a parent/guardian cannot be reached.
Additional Individual 1

First Name Last Name
Relationship
Phone Number
Please enter a valid phone number.
Additional Individual 2

First Name Last Name
Relationship
Phone Number
Please enter a valid phone number.

Allergies & Medical Conditions
Does your camper(s) have any allergies, chronic illnesses, or medical conditions? If yes, please describe. If no, write "none": *
Does your camper(s) have any medications that they will need to take during the course of the camp day? (If YES, you will be contacted for additional info prior to camp) *

Yes No

Tuition
If you are applying for a full or partial scholarship and unsure if your child would qualify for the Free and Reduced Lunch Program, please click here.

Please Select

Camp Tuition (First Child)

$ 200.00

Camp Tuition (Sibling)

$ 175.00

Extended Supervision Fee (Per Child) Extra supervision hours are 7:00-8:00 AM and 5:30-6:00 PM

$ 25.00 Quantity

I am applying for a FULL SCHOLARSHIP My Child qualifies for the FREE Lunch Program at School (LIMITED SPACES AVAILABLE)

$ 25.00 Quantity

I am applying for a PARTIAL SCHOLARSHIP My child qualifies for the REDUCED Lunch Program at school (LIMITED SPACES AVAILABLE)

$ 25.00 Quantity

Total

$ 0.00

Camper Information