Day Camp Registration Form

Summer Day Camp Registration
Camper's Information
Name

First NameLast Name
Birth Date

MonthDayYear
Age (at time of camp)
Grade (entering this fall)
T-shirt Size:
List Any Allergies and Dietary Restrictions
Medications & Frequency
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent / Guardian Information

(All correspondence and and invoices will be sent to this person)
Name

First NameLast Name
Email
example@example.com
Cell Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship with the Camper
Emergency Contacts and Authorized Pick Up Persons
Emergency Contacts and Authorized Pick Up Persons
Program Information
Select Camp Week
Date

MonthDayYear
Date
Signature

Registration $125.00

One-time registration fee.

Total $0.00

Credit Card

Apple Pay

Cash App Pay

Summer Day Camp Registration