2025Summer Camp Registration Form

Camp Registration form

Summer Day Camp July 28th-August 1st 2025
Child's Name*

First NameLast Name
Nickname
Date of Birth*

MonthDayYear
Gender

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you find out about us?*

Interest formSocial mediaWord of mouthSchool PTA
Academic information
School your child is currently attending*
Entering grade 2025/2026*

2nd grade
Parent/Guardian Information
Parent/Guardian's Name*

First NameLast Name
Relation
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone *
Please enter a valid phone number.
Work Phone
Please enter a valid phone number.
Email*
example@example.com
Name a second authorized pick up person.

First NameLast Name
Relation 2
Cell Phone
Please enter a valid phone number.
Work Phone
Please enter a valid phone number.

Emergency Contact Information
Emergency Contact*

First NameLast Name
Relationship
Emergency Contact Phone*
Please enter a valid phone number.
Emergency Contact Alternative Phone
Please enter a valid phone number.
Medical Information
Is your child's immunization record up to date?

YesNo
Health Insurance Company
Health Insurance Policy Number
Physician's Name
Are there any activities your child cannot participate in?
Does your child have any physical, mental, or medical conditions that require special attention or medication while at camp?
List any allergies

Payment Information

Camp cost is $325
Payment due at time of registration. Please make your payment electronically via Zelle using the email - hablaspanishcamp@gmail.com - to make payment.
Refund Policy
Cancellations and request for refunds should be made in writing or via email from the person who signed the registration. Refunds will be issued for cancellations prior to May 1st. A non-refundable processing fee of $50 will be taken from refund.

All fees become non-refundable after May 1st for any reason.
By hitting submit and putting your signature, you agree that you are the parent or legal guardian of the above named child, and are over the age of 18. In case of medical emergency or general medical care, I give consent for medical treatment for the above named child by authorized personnel. The camp carries secondary insurance. I understand that the above named child will only be released to the names listed above, an update may be done at registration. I certify that my child has my permission to attend camp and participate in all activites.
Signature

Clear
Should be Empty:

Camp Registration form