2024 Summer Camp Registration Form

Camper Information
Camper Name*
Nickname
Date of Birth*

MonthDayYear
Age
NOTE - Children need to be at least 16 months of age before they are eligible to participate in traditional day camp. Younger campers should meet the following requirements for admission into the toddler program: walk without assistance, feed him/her/themselves finger food, & follow simple directions (come with us, have a seat here, etc.)

For children to be admitted into the Primary community,(3-6years), campers must be able to use the toilet or urinal reliably. Due to staff to child ratios, pull-ups and diapers are not allowed in the Primary community.
A $50 materials fee will be added to your first invoice, per child, attending DGMS Summer Camp. This fee is non-refundable, one-time fee.

Cancellations should occur 10 days prior to the start of the canceled week of camp.

Half day dismissal is at 12:00 daily.

Please choose your preferred times for your child to attend DGMS Summer Camp (select all that apply)*

Camp drop off is from 8:30am - 9:00 everyday if not attending early care.

Half day dismissal is at 12:00.

Camp dismissal is from 3:30pm - 3:45pm daily. Students not gathered during carline will be sent to aftercare.

*Aftercare is $2/minute if not signed up for ahead of time*
Would you like your child to be enrolled in Early Care or After Care?

Early Care (7:30am-8:30am)After Care (3:45pm-5:30pm)
Please 'check' the weeks that you would your camper to attend DGMS Summer Camp.

June 3-7th : Camp CraftyJune 10-14th : Lost in SpaceJune 17-21st : Prehistoric PanicJune 24-28th : Author's RetreatJuly 1-3rd : Builder's ExplosionJuly 8-12th : Shark Week - Hoo Ha HaJuly 15-19th : Going Green with DGMSJuly 22-26th : Lets Bug Out
Please provide any additional information that you think is important or may affect the camper's ability to fully participate in the camp program.

Parents' Information

Parent/Guardian 1
Parent/Guardian 1*

First NameLast Name
Relationship to Child*
E-mail*
example@example.com
Cell Phone*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Work/School Name*
Or enter N/A if not applicable
Parent's Work/School Phone
Where would you like to be reached while your child is at camp?*

Cell PhoneWork Phone
Parent's Information (if applicable)

Parent/Guardian 2
Parent/Guardian 2

First NameLast Name
Relationship to Child
E-mail
example@example.com
Cell Phone
Home Address Same as Parent/Guardian 1?

Yes
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Work/School Name
Or enter N/A if not applicable
Parent's Work/School Phone
Where would parent/guardian 2 like to be reached while your child is at camp?

Cell PhoneWork Phone

Emergency Contacts/Authorized Pickup

Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be within one hour of the center/home, able to take responsibility for the child in case the parent/guardian cannot be contacted and should be at least 18 years of age. The first emergency contact must live no more than 1 hour away and be over the age of 18.
Emergency Contact Information

Emergency Contact #1
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Relationship to Child*
Emergency Contact Information

Emergency Contact #2
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Relationship to Child*

Payment Options

Please choose which type of payment option you would prefer for summer camp. Payment(s) can be made with check or cash to avoid Quickbook fees.
Would you prefer one invoice for the entire summer, monthly invoices, or weekly invoices based upon the weeks your camper is enrolled?*

One invoice (due before the start of summer camp)Monthly invoices (due before the start of the month)Weekly invoices (due before the start of the upcoming week)
This form, after being completed and signed by the parent/guardian, must be reviewed for completeness and signed by the summer camp director prior to the child receiving care. *
Type first and last name above to consent
Sign Document*
Date Signed*

MonthDayYear
Camp Director Name and Contact Info
Should be Empty:

Additional Information Request