Summer Camp Enrollment Form

Summer Camp Registration
CHILD INFORMATION:
Child Name*

First NameLast Name
Birth Date*

MonthDayYear
How old is your child as of registration
Name of School as of 2024-2025 school yr*
Grade entering for 2025-2026 school yr*
Will this child be attending with other household members?
Is this child in foster care?
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail*
example@example.com
Parent/Guardian 2 Information
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Emergency Contact

Other than parent/guardian
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
MEDICAL INFORMATION
Physician Name

First NameLast Name
Phone Number
Medical Concerns - please include allergies
Camp Consent

The weekly camp rate is $150 per child. Weekly payments must be completed to hold your child's place in camp every Wednesday prior to the week they are attending. Campers are expected to attend weekly but please notify us of any vacations ahead of time. We may be able to offer available weeks to campers from a waiting list.
I agree to make payments every Wednesday.

If your child received a scholarship voucher from Volusia County please note that they must begin on a Monday and the certificate must be submitted to us.
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