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:

Youth SmallAdult SmaillYouth MediumAdult MediumYouth LargeAdult Large
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

Week 1 - JuneWeek 5 - JulyWeek 2 - JuneWeek 6 - JulyWeek 3 - JuneWeek 7- JulyWeek 4- JulyWeek 8- JulyWeek 9 - AugustEntire Camp
Date

MonthDayYear
Date
Signature

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My Products

Registration $100.00

One-time registration fee.

Total $0.00

Credit Card

Apple Pay

Cash App Pay

Summer Day Camp Registration