MINI Camp Registration
Saturdays are THE BEST at HOTEA!
Date of MINI Camp that you are registering for:
Camper Information
Camper's Name
First Name
Last Name
Birth Date
Please select a month
January
February
March
April
May
June
July
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September
October
November
December
Month
Please select a day
1
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31
Day
Please select a year
2024
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2015
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2012
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1922
1921
1920
Year
Grade
Gender
Male
Female
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Information
Name
First Name
Last Name
Home Number
Cell Number
E-mail
example@example.com
Emergency Information
Emergency Contact's Name
First Name
Last Name
Relationship
Please Select
Mother
Father
Grandparent
Aunt
Uncle
Sibling
Babysitter/Nanny
Other
Phone Number
Alt. Phone Number
Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the camper prescribed an inhaler? If yes, please explain any instructions.
Date
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Month
-
Day
Year
Date
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MINI Camp
Camp is the last Saturday of the month. 9am - 12 pm
$
100.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit Form
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