Kamp Kaboom 2025 Registration Form

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Child Name* This field is required.
First Name
Last Name
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Birth Date* This field is required.
Month
Day
Year
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Grade entering in September * This field is required.
Students entering grades 3-6 ONLY for summer 2024
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Name of School* This field is required.
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Student Strengths (Social and Academic)
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Student Weakness (Social and Academic)
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Primary Parent/Guardian Name* This field is required.
First Name
Last Name
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Secondary Parent/Guardian Name* This field is required.
First Name
Last Name
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Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Work Phone Number* This field is required.
Area Code
Phone Number
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Cell Phone Number* This field is required.
Area Code
Phone Number
12
Secondary Cell Phone Number
Area Code
Phone Number
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E-mail* This field is required.
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Secondary E-mail* This field is required.
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Full Name* This field is required.
First Name
Last Name
16
Relationship to Camper* This field is required.
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Phone Number* This field is required.
Area Code
Phone Number
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Full Name
First Name
Last Name
19
Relationship to Camper
20
Phone Number
Area Code
Phone Number
21
Insurance coverage is a requirement to participate in any Kamp Kaboom Summer program activities.
I, the undersigned, Parent or Legal Guardian of the registered participant, certify that the name participant is covered by an insurance program with _______________________________Company, which will compensate for injuries incurred while participating in Kamp Kaboom Summer Activities.
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* This field is required.
Yes, I understand
No, I do not understand
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Insurance Company* This field is required.
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Physician Name* This field is required.
First Name
Last Name
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Medical Concerns- Please list any additional information the staff needs to be aware of for the well being of your child.
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I verify that my child is of good mental and physical health, and may participate in the Kamp Kaboom Summer Activities. I also verify that my child’s immunization shots are up to date. I give permission to authorize emergency care to my child in the event that neither I nor the physician can be contacted. I prefer my child be transported to _________________________ Hospital, in the case of an emergency.
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I agree to the above statement regarding my childs health
I do NOT agree to the above statement regarding my childs health
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Preferred Hospital* This field is required.
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Kamp Kaboom will opperate:

Monday, June 30th- July 31st 8am-3:30pm Monday- Thursday

Kampers should arrive by 9am to recieve breakfast and begin daily activites.

Kampers must be picked up no later than 3:30pm

Registration Fee:

There is a non-refundable registration fee of $50 per kamper.

Weekly Kamper Fee:

$160 Per Kamper per week

$210 for 2 siblings per week

All Paymets should be issued via the Kamp Kaboom Website. NO CASH PAYMENTS WILL BE ACCEPTED . Payments are due by 9:00am the Monday of the week your child attends.
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I have a clear understanding of payments and program hours* This field is required.
Yes
No
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ABSENCES DURING PROGRAM
I understand that in the event of any absences during program hours, I will be responsible for fees for time reserved, not for actual time spent at the program. This would include any vacation time.
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AUTHORIZED PICK UP
I understand that my child will not be released to any unauthorized person. I must show a form of identification and sign my child in and out daily.
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Full Name* This field is required.
First Name
Last Name
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Phone Number
Area Code
Phone Number
35
Full Name* This field is required.
First Name
Last Name
36
Phone Number
Area Code
Phone Number
37
I give my child permission to leave the program site for trips in a bus or chartered transportation to off-site locations and enrichment programs. I understand that I will be notified before each activity.

I give my child permission to walk to points of interest in close proximity to the program site under Kamp Kaboom director supervision.

I give permission to have my child appear in any Kamp Kaboom media coverage, advertisements or brochures.

I give my child permission to watch PG movies.
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* This field is required.
I do give my child permission to the above statements
I do not give my child permission to the above statements
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MEDICAL AUTHORIZATION
I authorize the Kamp Kaboom Site Coordinator or designee to administer medication when necessary. I understand that I will have to sign a medication authorization form before any medication can be administered. Kamp Kaboom staff will not administer shots (other than an Epi Pen) or suppositories.

STAFFING
I understand that Kamp Kaboom is not staffed to serve children who need one on one direct care. The ratio of children to staff is 10 to 1. All children who attend Kamp Kaboom must be able to use the toilet without assistance.

KAMP KABOOM BEHAVIOR POLICY
I understand that my child will have to abide by the Kamp Kaboom policies and procedures to ensure that each participant is safe and plays fairly. My child will be taken away from activities when he/she cannot behave in a safe and expected manner. I will be informed of unacceptable behavior and asked to sign a discipline form. I understand that fighting of any kind will not be tolerated and will result in an automatic suspension. If behavior continues to be a problem, the Site Coordinator will have the discretion to suspend my child from the program. If behavior does not improve, as a last resort, my child will be removed from the program for the duration of summer camp. Kamp Kaboom employees do not use corporal punishment.
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Registration Fee Each registratan will recieve a Kamp Kaboom drawstring back pack, water bottle and a t-shirt for trip days

The registration rate is $50.00 per child registered for Kamp Kaboom, LLC

Weekly Payment

The 2025 summer weekly rate is $160.00. This rate includes academic enrichment materials, hands-on activities, weekly trips, transportation, breakfast, lunch, snack and much more.

WHERE TO MAKE PAYMENTS
Payments may also be made online only at the Kamp Kaboom website. I understand that full payment is due for every registered week during the summer. Kamp Kaboom cannot refund due to absences, illness, inclement weather or vacations.
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By signing this form, I understand and agree to the policies set forth upon this document.
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Full Name* This field is required.
First Name
Last Name
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Date
Date
Month
Day
Year
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Please Indicate your child's T-Shirt Size *additional t-shirts available for purchase $5.00* This field is required.
Child Small
Child Medium
Child Large
Adult Small
Adult Medium
Adult Large
Adult Extra Large
Other
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Non- Refundable 2023 Kamp Kaboom Registration
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