2023 Day Camp Registration Form

Day Camp Registration

Camp is for ages 5-13
PLEASE CHOOSE ONE*
Referred By:
Number of Children*
CHILD INFORMATION:
CHILD #1 - $225.00/WEEK-DAILY RATE $50.00
Child Name*

First NameLast Name
Gender*
Current Age*
Birth Date*

MonthDayYear
Shirt Size*
Grade Leaving*
ex. K4
School Name*
ALLERGIES OR MEDICAL CONDITION
****SELECTING CAMP WEEKS AND DAYS****
Please note that our options to choose your week or days looks a bit different this year. Below you will choose which weeks you would like your camper to attend. If you choose weekly, then you can move through to the next steps of the registration. If you choose daily, it will ask to select which days of that week that you want your camper to attend. Please note that whether you select weekly or daily rate, and you are a "no show", your account will still be charged for either the daily or weekly rate. ***No-Shows: Extreme cases of emergency (funeral, extended illness, or injury) for not attending for a reserved day or week, will be at the discretion of VFDC as to whether an account can be exempt from being charged. Once the registration has been submitted you will be unable to cancel.
Mark All That Apply*

Week 1: June 12-June 16Week 2: June 19-June 23Week 3: June 26- June 30Week 4: July 3- July 7Week 5: July 10-July 14Week 6: July 17-July 21Week 7: July 24-July 28Week 8: July 31-August 4Week 9: August 7- August 11
Do you have daily rate needs?*

YesNo
Which weeks would you like daily? *

Week 1: June 12-June 16Week 2: June 19-June 23Week 3: June 26- June 30Week 4: July 3- July 7Week 5: July 10-July 14Week 6: July 17-July 21Week 7: July 24-July 28Week 8: July 31-August 4Week 9: August 7- August 11
Week 1 Mark All That Apply*

Monday, June 12Tuesday, June 13Wednesday, June 14Thursday, June 15Friday, June 16
Week 2 Mark All That Apply*

Monday, June 19Tuesday, June 20Wednesday, June 21Thursday, June 22Friday, June 23
Week 3 Mark All That Apply*

Monday, June 26Tuesday, June 27Wednesday, June 28Thursday, June 29Friday, June 30
Week 4: Mark All That Apply*

Wednesday, July 5Thursday, July 6Friday, July 7
Week 5: Mark All That Apply*

Monday, July 10Tuesday, July 11Wednesday, July 12Thursday, July 13Friday, July 14
Week 6: Mark All That Apply*

Monday, July 17Tuesday, July 18Wednesday, July 19Thursday, July 20Friday, July 21
Week 7: Mark All That Apply*

Monday, July 24Tuesday, July 25Wednesday, July 26Thursday, July 27Friday, July 28
Week 8: Mark All That Apply*

Monday, July 31Tuesday, August 1Wednesday, August 2Thursday, August 3Friday, August 4
Week 9: Mark All That Apply*

Monday, August 7Tuesday, August 8Wednesday, August 9Thursday, August 10
Total # of Weeks Attending Camp*
CHILD #2 - $205.00/WEEK-$45.00 DAILY RATE
Child Name*

First NameLast Name
Gender*
Birth Date*

MonthDayYear
Current Age*
Shirt Size*
Grade Leaving*
ex. K4
School Name*
ALLERGIES OR MEDICAL CONDITION-
Mark All That Apply*

Week 1: June 12-June 16Week 2: June 19-June 23Week 3: June 26- June 30Week 4: July 3- July 7Week 5: July 10-July 14Week 6: July 17-July 21Week 7: July 24-July 28Week 8: July 31-August 4Week 9: August 7- August 11
Do you have daily rate needs?*

YesNo
Which weeks would you like daily? *

Week 1: June 12-June 16Week 2: June 19-June 23Week 3: June 26- June 30Week 4: July 3- July 7Week 5: July 10-July 14Week 6: July 17-July 21Week 7: July 24-July 28Week 8: July 31-August 4Week 9: August 7- August 11
Week 1 Mark All That Apply*

Monday, June 12Tuesday, June 13Wednesday, June 14Thursday, June 15Friday, June 16
Week 2 Mark All That Apply*

Monday, June 19Tuesday, June 20Wednesday, June 21Thursday, June 22Friday, June 23
Week 3 Mark All That Apply*

Monday, June 26Tuesday, June 27Wednesday, June 28Thursday, June 29Friday, June 30
Week 4: Mark All That Apply*

Wednesday, July 5Thursday, July 6Friday, July 7
Week 5: Mark All That Apply*

Monday, July 10Tuesday, July 11Wednesday, July 12Thursday, July 13Friday, July 14
Week 6: Mark All That Apply*

Monday, July 17Tuesday, July 18Wednesday, July 19Thursday, July 20Friday, July 21
Week 7: Mark All That Apply*

Monday, July 24Tuesday, July 25Wednesday, July 26Thursday, July 27Friday, July 28
Week 8: Mark All That Apply*

Monday, July 31Tuesday, August 1Wednesday, August 2Thursday, August 3Friday, August 4
Week 9: Mark All That Apply*

Monday, August 7Tuesday, August 8Wednesday, August 9Thursday, August 10
Total # of Weeks*
CHILD #3 - $205.00/WEEK-$45.00 DAILY RATE
Child Name*

First NameLast Name
Gender*
Birth Date*

MonthDayYear
Current Age*
Shirt Size*
Grade Leaving*
ex. K4
School Name*
ALLERGIES OR MEDICAL CONDITION-(If your child is attending days, please use this area to indicate that in this section as well.)
Mark All That Apply*

Week 1: June 12-June 16Week 2: June 19-June 23Week 3: June 26- June 30Week 4: July 3- July 7Week 5: July 10-July 14Week 6: July 17-July 21Week 7: July 24-July 28Week 8: July 31-August 4Week 9: August 7- August 11
Do you have daily rate needs?*

YesNo
Which weeks would you like daily? *

Week 1: June 12-June 16Week 2: June 19-June 23Week 3: June 26- June 30Week 4: July 3- July 7Week 5: July 10-July 14Week 6: July 17-July 21Week 7: July 24-July 28Week 8: July 31-August 4Week 9: August 7- August 11
Week 1 Mark All That Apply*

Monday, June 12Tuesday, June 13Wednesday, June 14Thursday, June 15Friday, June 16
Week 2 Mark All That Apply*

Monday, June 19Tuesday, June 20Wednesday, June 21Thursday, June 22Friday, June 23
Week 3 Mark All That Apply*

Monday, June 26Tuesday, June 27Wednesday, June 28Thursday, June 29Friday, June 30
Week 4: Mark All That Apply*

Wednesday, July 5Thursday, July 6Friday, July 7
Week 5: Mark All That Apply*

Monday, July 10Tuesday, July 11Wednesday, July 12Thursday, July 13Friday, July 14
Week 6: Mark All That Apply*

Monday, July 17Tuesday, July 18Wednesday, July 19Thursday, July 20Friday, July 21
Week 7: Mark All That Apply*

Monday, July 24Tuesday, July 25Wednesday, July 26Thursday, July 27Friday, July 28
Week 8: Mark All That Apply*

Monday, July 31Tuesday, August 1Wednesday, August 2Thursday, August 3Friday, August 4
Week 9: Mark All That Apply*

Monday, August 7Tuesday, August 8Wednesday, August 9Thursday, August 10
Total # of Weeks*
CHILD #4 - $205.00/WEEK-$45.00 DAILY RATE
Child Name*

First NameLast Name
Gender*
Birth Date*

MonthDayYear
Current Age*
Shirt Size*
Grade Leaving*
ex. K4
School Name*
ALLERGIES OR MEDICAL CONDITION-(If your child is attending days, please use this area to indicate that in this section as well.)
Mark All That Apply*

Week 1: June 12-June 16Week 2: June 19-June 23Week 3: June 26- June 30Week 4: July 3- July 7Week 5: July 10-July 14Week 6: July 17-July 21Week 7: July 24-July 28Week 8: July 31-August 4Week 9: August 7- August 11
Do you have daily rate needs?*

YesNo
Which weeks would you like daily? *

Week 1: June 12-June 16Week 2: June 19-June 23Week 3: June 26- June 30Week 4: July 3- July 7Week 5: July 10-July 14Week 6: July 17-July 21Week 7: July 24-July 28Week 8: July 31-August 4Week 9: August 7- August 11
Week 1 Mark All That Apply*

Monday, June 12Tuesday, June 13Wednesday, June 14Thursday, June 15Friday, June 16
Week 2 Mark All That Apply*

Monday, June 19Tuesday, June 20Wednesday, June 21Thursday, June 22Friday, June 23
Week 3 Mark All That Apply*

Monday, June 26Tuesday, June 27Wednesday, June 28Thursday, June 29Friday, June 30
Week 4: Mark All That Apply*

Wednesday, July 5Thursday, July 6Friday, July 7
Week 5: Mark All That Apply*

Monday, July 10Tuesday, July 11Wednesday, July 12Thursday, July 13Friday, July 14
Week 6: Mark All That Apply*

Monday, July 17Tuesday, July 18Wednesday, July 19Thursday, July 20Friday, July 21
Week 7: Mark All That Apply*

Monday, July 24Tuesday, July 25Wednesday, July 26Thursday, July 27Friday, July 28
Week 8: Mark All That Apply*

Monday, July 31Tuesday, August 1Wednesday, August 2Thursday, August 3Friday, August 4
Week 9: Mark All That Apply*

Monday, August 7Tuesday, August 8Wednesday, August 9Thursday, August 10
Total # of Weeks*
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Name

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
EMERGENCY CONTACT-Please list someone other than yourself as an Emergency Contact, as we would contact you first.
Contact Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Relationship to Child*
IMPORTANT INFORMATION
Your non-refundable pre-registration fee of $75 must be paid in order to process your registration. All deposits are non-refundable and non-transferrable. All payments are received via Tuition Express. All returned payments due to NSF (non-sufficient funds) from a checking account or credit card declines, will be charged a $35 processing fee. Valley Forge Day Camp reserves the right to make all final decisions and changes to this policy.

I understand the risks of physical injury associated with participation in the activities at VFDC, my financial responsibilities listed above, and consent of the following: I shall not hold Valley Forge Day Camp responsible or legally liable for losses of personal property or bodily injury; my child may participate in all camp activities unless otherwise stated. If a dispute over this agreement or any claim for damages arises, the parent/guardian agrees to resolve the matter through a mutually acceptable arbitration process. My signature below verifies that I am the parent or legal guardian of the child(ren) above and agree to the above statements.
*
OR
Please Sign Below*

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Camper Registration Fee*

Day Camp Registration Fee$75.00

Registration fee covers each individual camper. You must select the number according to the number of campers you are registering.

Quantity

Total $0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

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Day Camp Registration

CHILD INFORMATION:

PARENT/GUARDIAN INFORMATION:

EMERGENCY CONTACT-Please list someone other than yourself as an Emergency Contact, as we would contact you first.

IMPORTANT INFORMATION