Summer Camp Detailed Registration Form

Camper's Name 1

First NameLast Name

Camper's Name 2

First NameLast Name

Camper's Name 3

First NameLast Name

Ages

Gender

T-shirt size (Youth)

YesNo

Parent/Guardian Information

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Number

Format: (000) 000-0000.

Cell Number

Format: (000) 000-0000.

E-mail

example@example.com

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Format: (000) 000-0000.

Alt. Phone Number

Format: (000) 000-0000.

Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is the camper prescribed any medications? If yes, please explain any instructions.

YesNo

Camp Weeks - Sibling Discount ($20) reflected in multiple children registration

Pokémon Palooza Art Camp - June 8 - 12

M - F 8:30am - 12:30pm

Ages: 6-12 Come create your favorite Pokémon's during this art filled week and let your imagination run wild. Snacks and T-shirts provided.

$185.00 Quantity

Blocky Creations: Minecraft Art Adventure - June 15 - 19

M - F 8:30am - 12:30pm

Ages: 6-12

Right out of the Minecraft world, you will use your talent to create and build your own world. Snacks, and T-shirts provided.

$185.00 Quantity

K-Pop Demon Hunters: Slaying the Stage with Art - July 6-9

M-Th 8:30am -12:30pm

Ages: 6-12 Dance and sing your way through magical art as a Huntrix or Saja Boy you can create your own Golden moments on canvas and with crafts.

Snack will be provided. **T-shirts are provided.

$185.00 Quantity

Whimsical Woodlands Faries, Gnomes and Dragons - July 13 - 17th

M-F 8:30am- 12:30pm

Ages 6-12 Gnomes and fairies everywhere! This camp will help young artists capture their inner gnome or fairy while creating additions to the family garden. Snack and T-shirt will be provided.

$185.00 Quantity

Game Makers: Design awesome board games - July 27 - 30

M - Th 8:30am - 12:30pm

Ages: 6-12 Are you a gamer? Put that phone down and let's create games from our imaginations to play with friends, siblings and parents. We will use recycled materials, paint, markers and creativity to build our games. Snacks and T-shirt provided.

$185.00 Quantity

Total

$0.00

Credit Card

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.

Date

Signature

Summer Camp Registration

Camper Information

Credit Card