PEBC Winter Day Camp Registration

Child's Name*

First NameLast Name
Birth Date

MonthDayYear
Grade in 2024-2025 School Year:
I consent to photos of my child being taken. Photos are often taken of kids doing activities and may be used for future PEBC publications and social media.*

YesNo
Allergies/Health Concerns:*
Which sessions would your child like to attend?

January 20th - NERVES and MUSCLES and BONES, Oh My!February 14th - Matters of the Heart...and LungsFebruary 17th - Germ BustersMarch 28th - From Food to Feces
Add Another Child?

Yes

Child's Name*

First NameLast Name
Birth Date

MonthDayYear
Grade in 2024-2025 School Year:
I consent to photos of my child being taken. Photos are often taken of kids doing activities and may be used for future PEBC publications and social media.*

YesNo
Allergies/Health Concerns:*
Which sessions would your child like to attend?

January 20th - NERVES and MUSCLES and BONES, Oh My!February 14th - Matters of the Heart...and LungsFebruary 17th - Germ BustersMarch 28th - From Food to Feces
Add Another Child?

Yes

Child's Name*

First NameLast Name
Birth Date

MonthDayYear
Grade in 2024-2025 School Year:
I consent to photos of my child being taken. Photos are often taken of kids doing activities and may be used for future PEBC publications and social media.*

YesNo
Allergies/Health Concerns:*
Which sessions would your child like to attend?

January 20th - NERVES and MUSCLES and BONES, Oh My!February 14th - Matters of the Heart...and LungsFebruary 17th - Germ BustersMarch 28th - From Food to Feces
Add Another Child?

Yes

Child's Name*

First NameLast Name
Birth Date

MonthDayYear
Grade in 2024-2025 School Year:
I consent to photos of my child being taken. Photos are often taken of kids doing activities and may be used for future PEBC publications and social media.*

YesNo
Allergies/Health Concerns:*
Which sessions would your child like to attend?

January 20th - NERVES and MUSCLES and BONES, Oh My!February 14th - Matters of the Heart...and LungsFebruary 17th - Germ BustersMarch 28th - From Food to Feces

Have you ever received a scholarship to PEBC camps before?

YesNo
When?
How did you hear about our scholarship program?
Please select if your child is a part of these groups.

Big BuddiesHeron Lake Caring Connections
How would your child benefit from being at a PEBC camp?
Is your child eligible for free or reduced lunch?

YesNo
Please list any financial circumstances that you would like to have considered as a basis for awarding this scholarship.
Is there anything else you would like for us to know?

Winter Day Camp Payment

NERVES and MUSCLES and BONES, Oh My!January 20th 8:30 to 3:00

$50.00 Quantity

Matters of the Heart...and LungsFebruary 14th 8:30 to 3:00

$50.00 Quantity

Germ BustersFebruary 17th 8:30 to 3:00

$50.00 Quantity

From Food to FecesMarch 28th 8:30 to 3:00

$50.00 Quantity

Enter coupon

Total

$0.00

PEBC K-3 Winter Day Camps