Summer Camp Detailed Registration Form

Peas in a Pod Summer Camp 2025

Camper Registration
Camper Information
Camper's Name

First NameLast Name
Birth Date

MonthDayYear
Gender

MaleFemaleNon-binary
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Home Number
Cell Number
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Alt. Phone Number
Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the camper prescribed an medications? If yes, please list.
Which weeks would you like to sign up for? Select as many as needed!

Week 1 - Bubbles (June 30 - July 4)Week 2 - Curious Creatures (July 7 - July 1)Week 3 - Under the Stars (July 17 - July 18)Week 4 - Down on the Farm (July 21 - July 25Week 5 - Wide World of Sports (July 28 - August 1)Week 6 - Bounce Around (August 4 - August 8)Week 7 - Culinary Creations (August 11 - August 15)Week 8 - Carnival (August 18 - August 22)
Add Weekly In-House Field Trip? Select as many as needed!

Week 1 - Bubble Week Field Trip Add-on (+$10)Week 2 - Curious Creatures Week Field Trip Add-on (+$10)Week 3 - Under the Stars Week Field Trip Add-on (+$10)Week 4 - Down on the Farm Week Field Trip Add-on (+$10)Week 5 - Wide World of Sports Week Field Trip Add-on (+$10)Week 6 - Bounce Around Week Field Trip Add-on (+$10)Week 7 - Culinary Creations Week Field Trip Add-on (+$10)Week 8 - Carnival Week Field Trip Add-on (+$10)
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Name

First NameLast Name
Date

MonthDayYear
Date
Signature

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Peas in a Pod Summer Camp 2025

Camper Information