2023 Summer Camp Registration Form

Summer Camp Registration
AGES 6-12

DAY CAMP COST
$125 WEEKLY FOR FULL DAY CAMP

NO REFUNDS OR CREDITS FOR DAYS NOT ATTENDED.

MORNINGS ONLY 8:30AM-12:30PM $75 WEEKLY

$30 DAILY DROP IN FEE PLUS FIELD TRIP COSTS.
REQUEST AND APPROVAL THROUGH THE GENERAL MANAGER ONLY
Childs Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade*
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Short Medical #*
Long Medical #*
Parent/Guardian Information
Name*

First NameLast Name
Home Number*

Area CodePhone Number
Cell Number*

Area CodePhone Number
E-mail*
Camp Weeks *

Week 1 JULY 3-7Week 2 JULY 10-14Week 3 JULY 17-21Week 4 JULY24-28Week 5 JULY 31-AUGUST 4Week 6 AUGUST 8-11 SHORT WEEKWEEK 7 AUGUST 14-18WEEK 8 AUGUST 21-25WEEK 9 AUGUST 28-SEPT 1
Emergency Information
Emergency Contact's Name ( not guardian)*

First NameLast Name
Phone Number*

Area CodePhone Number
Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Behavior Concerns including triggers and any special emotions. Every bit helps make your childs camp experience a better one
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
E-mail
Should be Empty: