Broadmoor United Methodist Summer Day Camp 2022 Registration Form

Broadmoor United Methodist Summer Day Camp 2023 Registration Form
Child's Information

Each Child Must Be Registered Separately
Child's Name*

First NameLast Name
What Grade did your child just complete?*
Date of Birth*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Known Allergies or Medical Conditions and Current Medications*
Indicate below the weeks for which you are registering*

Week 1 (May 22-26)Week 2 (May 30-June 2) Closed May 29thWeek 3 (June 5-9)Week 4 (June 12-16)Week 5 (June 19-23)Week 6 (June 26- June 30)Week 7 (July 5-7) Closed July 3rd and 4thWeek 8 (July 10-14)Week 9 (July 17-21)Week 10 (July 24-28)Week 11 (July 31-August 2) Closed August 3rd and 4th for teacher planning
Program Type: Full day (7am-5:45pm)*

5 Full Days $225/week4 Full Days$180/week3 Full Days $135/week2 Full Days $90/week
Parent Information
Parent/Guardians Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardians Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Pick Up List- Please indicate names and phone numbers of any other people you will allow to pick up your child.*
T-Shirt Size*

Youth Extra SmallYouth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult Extra Large
How Did You Hear About Us*

FacebookYelpParents BlogWord of Mouth
Permissions and Agreements
- The registration fee is due at the time of registration.
- Tuition payments are due at the start of each week that will be attended
A 10% discount is offered to those paying for 5 weeks or more in one payment.
I agree to pay tuition as stated above.*
We are an electronic free camp for all campers. Campers are not allowed to bring ipods/mp3 players, phones, electronic games, etc. to camp. If the device is brought to camp, it will be placed in the office until picked up by a parent. Broadmoor is not responsible for any toy/ device that is lost, stolen, or broken.*
WE ARE A NUT FREE FACILITY. Parents will provide a NUT FREE lunch every day with a drink. No “hard coolers” please. We will provide a morning and afternoon snack. Water will be available to thechildren throughout the day.*
Campers will receive one camp t-shirt. Campers are required to wear the shirt on all field trips. *
I give Broadmoor United Methodist Summer Day Camp permission to use my child’s photographs for any sponsored advertising including but not limited to the website, Facebook, Instagram, and in print free of charge.*
Emergency: I permit Broadmoor United Methodist Summer Day Camp to secure medical treatment for my child.*
Please sign indicating you agree to all statements above.
Signature*
Today's Date*

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Date
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Broadmoor United Methodist Summer Day Camp 2023 Registration Form

Child's Information

Parent Information

Permissions and Agreements