Spring Camp Registration Form
March 24-28, 2025
General Information
Student Name
First Name
Middle Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Birth Date
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Gender
Please Select
Prefer Not To Answer
Female
Male
Gender Neutral
Other
Current Grade in School
Back
Next
Residence Information
Parent/ Guardian Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Back
Next
Emergency Contact Information
Primary Emergency | Contact Name
First Name
Last Name
Primary Emergency | Phone Number
Please enter a valid phone number.
Primary Emergency | What is your relationship with this person?
Secondary Emergency | Contact Name
First Name
Last Name
Secondary Emergency | Phone Number
Please enter a valid phone number.
Secondary Emergency | What is your relationship with this person?
Back
Next
Medical Information
Physician Name
First Name
Last Name
Physician Primary Phone Number
Please enter a valid phone number.
Physician Secondary Phone Number
Please enter a valid phone number.
Preferred Emergency Hospital Name
Please list any of the following; current medications, medication allergies, food allergies, or chronic health concerns.
Back
Next
I would like my child to attend Spring Camp on the following dates:
*
Monday, March 24
Tuesday, March 25
Wednesday, March 26
Thursday, March 27
Friday, March 28
The entire week
Do you grant permission for your child to participate in outdoor, off-site activities?
*
Yes
No
Do you grant permission for your child’s photo to be taken and used for camp updates and promotions?
*
Yes
No
Registration Option:
*
Full Week - $250
Select Days - Please indicate above. $60 per day
Is there anything else you would like us to know about your child?
Your Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Signature
*
Submit
Should be Empty: