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2025 Summer Camp Registration
Please fill out all necessary fields to enroll your child or teen in our Summer Camp programs at Kimball Jenkins. Note: please fill out separate registration forms for siblings.
Date
*
-
Month
-
Day
Year
Date
Parent/Guardian Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
*
example@example.com
Emergency Contact Information
Please list an emergency contact that is not the parent/guardian listed above.
Emergency Contact's Name (cannot be primary parent)
*
First Name
Last Name
Relationship
Please Select
Parent/ Guardian
Step-Parent
Grandparent
Aunt
Uncle
Sibling
Babysitter/Nanny
Other
Phone Number
*
2nd Emergency Contact's Name
*
First Name
Last Name
Relationship
*
Please Select
Parent/ Guardian
Step-Parent
Grandparent
Aunt
Uncle
Sibling
Babysitter/Nanny
Other
Phone Number
*
Will anyone besides you or the emergency contact names listed be picking up your child from camp? If so, please list their names and phone numbers below. (All adults must have their ID ready for drop off and pick up times.)
*
Name: Camper Name
*
First Name
Last Name
Camper Age and Birthdate
*
Does your child/teen have any allergies, chronic illness, medical or behavioral conditions we need to know about?
*
MEDIA RELEASE: I allow the staff of Kimball Jenkins to take photographs and/or videos of summer camp participants. Please note that your student's full name will not be listed with their picture unless additional permission is granted by you. These photos will be used exclusively for informational and promotional purposes only and under no circumstances will be distributed for sale.
*
YES
NO
Are you using our multi-session discount below to register siblings for this program? If so, please indicate a YES or NO below, along with the names of each sibling you plan on registering.
*
Please choose which camp session you want to enroll your camper in. Please read all selections carefully, as there is a multi-session discount option below Early Bird Registration selections.
*
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EARLY BIRD PRICE: ART OF OZ 9am-2pm (July 7-18)
Early bird registration for ART OF OZ, July 7-18, 9am-2pm (Enrollment fee after April 30: $675)
$
650.00
EARLY BIRD PRICE: ART OF OZ 9am-4pm (July 7-18)
Early bird registration for ART OF OZ, July 7-18, with extended open rec time, 9am-4pm (Enrollment fee after April 30: $725)
$
700.00
MULTI-SESSION DISCOUNT: ART OF OZ 9am-2pm (July 7-18)
MULTI-SESSION DISCOUNT: Register for two or three sessions of camp at one time and receive $25 off per session (great deal for sibling campers!) **Please note: later additions to camp registration do not qualify for the discount. Discount only applies to individual campers registering for more than one session or siblings within the same household at the time of initial registration.
$
625.00
Quantity
1
2
3
4
5
6
7
8
9
10
MULTI-SESSION DISCOUNT: ART OF OZ 9am-4pm (July 7-18)
MULTI-SESSION DISCOUNT: Register for two or three sessions of camp at one time and receive $25 off per session (great deal for sibling campers!) **Please note: later additions to camp registration do not qualify for the discount. Discount only applies to individual campers registering for more than one session or siblings within the same household at the time of initial registration.
$
675.00
Quantity
1
2
3
4
5
6
7
8
9
10
EARLY BIRD PRICE: MIXED MEDIA MASHUP 9am-2pm (July 21-August 1)
Early bird registration for MIXED MEDIA MASHUP, July 21-August 1, 9am-2pm (Enrollment fee after April 30: $675)
$
650.00
Quantity
1
2
3
4
5
6
7
8
9
10
EARLY BIRD PRICE: MIXED MEDIA MASHUP 9am-4pm (July 21-August 1)
Early bird registration for MIXED MEDIA MASHUP, August 4-15, 9am-4pm (Enrollment fee after April 30: $725)
$
700.00
Quantity
1
2
3
4
5
6
7
8
9
10
MULTI-SESSION DISCOUNT: MIXED MEDIA MASHUP 9am-2pm (July 21-August 1)
MULTI-SESSION DISCOUNT: Register for two or three sessions of camp at one time and receive $25 off per session (great deal for sibling campers!) **Please note: later additions to camp registration do not qualify for the discount. Discount only applies to individual campers registering for more than one session or siblings within the same household at the time of initial registration.
$
625.00
Quantity
1
2
3
4
5
6
7
8
9
10
MULTI-SESSION DISCOUNT: MIXED MEDIA MASHUP 9am-4pm (July 21-August 1)
MULTI-SESSION DISCOUNT: Register for two or three sessions of camp at one time and receive $25 off per session (great deal for sibling campers!) **Please note: later additions to camp registration do not qualify for the discount. Discount only applies to individual campers registering for more than one session or siblings within the same household at the time of initial registration.
$
675.00
Quantity
1
2
3
4
5
6
7
8
9
10
EARLY BIRD PRICE: NATURE'S PALETTE 9am-2pm (August 4-15)
Early bird registration for NATURE'S PALETTE, August 4-15, 9am-2pm (Enrollment fee after April 30: $675)
$
650.00
Quantity
1
2
3
4
5
6
7
8
9
10
EARLY BIRD PRICE: NATURE'S PALETTE 9am-4pm (August 4-15)
Early bird registration for NATURE'S PALETTE, August 4-15, 9am-4pm (Enrollment fee after April 30: $725)
$
700.00
Quantity
1
2
3
4
5
6
7
8
9
10
MULTI-SESSION DISCOUNT: NATURE'S PALETTE 9am-2pm (August 4-15)
MULTI-SESSION DISCOUNT: Register for two or three sessions of camp at one time and receive $25 off per session (great deal for sibling campers!) **Please note, later additions to camp registration do not qualify for the discount. Discount only applies to individual campers registering for more than one session or siblings within the same household at the time of initial registration.
$
625.00
Quantity
1
2
3
4
5
6
7
8
9
10
MULTI-SESSION DISCOUNT: NATURE'S PALETTE 9am-4pm (August 4-15)
MULTI-SESSION DISCOUNT: Register for two or three sessions of camp at one time and receive $25 off per session (great deal for sibling campers!) **Please note, later additions to camp registration do not qualify for the discount. Discount only applies to individual campers registering for more than one session or siblings within the same household at the time of initial registration.
$
675.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Signature
*
How did you hear about our summer camp? (optional)
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