Fort Myers Summer Camp Registration
Family Information
Parent Name
*
First Name
Last Name
Primary Email
*
example@example.com
Primary Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Back
Next
Camper Information
Camper Name
*
First Name
Last Name
Preferred Name
*
Birthdate
*
-
Month
-
Day
Year
Age
*
Please Select
4
5
6
7
8
9
10
11
12
13
14
Back
Next
Medical Information
Does this camper have any medical conditions, health problems, allergies, dietary needs, learning differences, or other concerns we should be aware of?
*
Is this camper currently using any medication we should be aware of?
*
Emergency Contacts and Authorized Pick Up
The individuals in this section will be contacted in the event of an emergency, IF the parent listed in section 1 are unable to be reached. The individuals listed here and the parent in section 1 are authorized to pick up this student from Camp HSR! and to receive information regarding this student.
Second Parent or Emergency Contact
*
First Name
Last Name
Second Parent or Emergency Contact Phone Number
*
Please enter a valid phone number.
Third Emergency Contact
*
First Name
Last Name
Third Emergency Contact Phone Number
*
Please enter a valid phone number.
By registering for Summer Camp, permission is granted to use any photographs or videos of your child in connection with publicity for Fort Myers Summer Camp Photos and videos may be posted on Facebook, Instagram, our website, and other social media. Photos may also be printed for distribution. We will never attach a child's name or personal information to any photo or video without explicit written permission.
*
Agree
By registering for Summer Camp, you agree to the program policies and procedures (available on our website).
*
Agree
Back
Next
Program Selection
Choose which weeks your camper would like to attend. If your Classic Camper (ages 6-10) attends a complete 3-week session (week 1-3 AND/OR week 4-6) you can choose to add on a Hobby to participate in daily.
Program Selection
*
Categories:
All
All
Session A
Session B
prev
next
( X )
Session A
Session A + Hobby
June 10-28 Classic Campers Only (ages 6-10)
$
555.00
Choose a hobby
Animation
Theatre
Geography Adventure
June 10 - 14
Week #1
$
175.00
Program Option
Junior Camper (3-5)
Classic Camper (6-10)
Counselor-in-Training (11-14)
June 17 - 21
Week #2
$
175.00
Program Option
Junior Camper (3-5)
Classic Camper (6-10)
Counselor-in-Training (11-14)
June 24 - 28
Week #3
$
175.00
Program Option
Junior Camper (3-5)
Classic Camper (6-10)
Counselor-in-Training (11-14)
Session B
Session B + Hobby
July 8-19 Classic Campers Only. (ages 6-10)
$
380.00
Choose a hobby
Survival Skills
Coding
Fine Arts
July 8 - 12
Week #4
$
175.00
Program Option
Junior Camper (3-5)
Classic Camper (6-10)
Counselor-in-Training (11-14)
July 15 - 19
Week #5
$
175.00
Program Option
Junior Camper (3-5)
Classic Camper (6-10)
Counselor-in-Training (11-14)
loading smart payment buttons...
The payment is ready! It will be completed once you submit the form.
Submit
Should be Empty: