SUMMER CAMP ENROLLMENT FORM
Child Name
*
First Name
Last Name
Child Age
*
Parent Name
*
First Name
Last Name
Email
*
example@example.com
Mobile Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Name
First Name
Last Name
Emergency Contact Telephone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
I WOULD LIKE TO ENROLL FOR THE FOLLOWING WEEKS
*
Week 1 (June 23-June 27)
Week 2 (June 30-July 4)
Week 3 (July 7-July 11)
Week 4 (July 14-18)
Week 5 (July 21-25)
Week 6 (July 28-August 1)
Week 7 (August 4-August 8)
Week 8 (August 11-August 15)
Week 9 (August 18-August 22)
Week 10 (August 25-29)
Submit
Should be Empty: