Summer Camp Enrollment Form

West Linn Bounce Summer Camp Registration
Which camp would your child like to attend?
CHILD INFORMATION:
Child Name

First NameLast Name
Birth Date

MonthDayYear
Grade
Name of School
Child Name

First NameLast Name
Birth Date

MonthDayYear
Name of School
Grade
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail
MEDICAL INFORMATION
Physician Name

First NameLast Name
Phone Number

Area CodePhone Number
Who is Authorized To Pick up Your Child(ren)?

Other
Medical Concerns
Any Allergies?
Please Describe
Please submit camp fee for $380 per child / per week via Venmo:

@Suzanne-Oliver-1
Should be Empty:

West Linn Bounce Summer Camp Registration