2026 Camp Registration Form

2026 Camp Registration Form

Ages 2 yrs-6 yrs ($100/week, 9:30 a.m. - 1 p.m.)
Messy Art (June 16-18)Animal Safari (June 23-25)Superhero School (July 7-9)STEAM Teams (July 21-23)We All Scream for Ice Cream (August 4-6)
Child's Name*

First NamePreferred/ nicknameLast Name
Birth Date

MonthDayYear
Schools attended:
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent 1 Name*

First NameLast Name
Parent 1 Mobile Number*
Format: (000) 000-0000.
Parent 1 Email *
example@example.com
Parent 2 Name

First NameLast Name
Parent 2 Email
example@example.com
Parent 2 Mobile Number
Format: (000) 000-0000.
Please list any siblings
Child's Primary Physician
Physician Phone Number
Format: (000) 000-0000.
Hospital Preference
Emergency Contact
Emergency Contact Phone Number:
Format: (000) 000-0000.
Food Allergies or other pertinent health concerns:
Current Medications
Any child who might need to have medications administered during camp hours is required to have a Medication Consent Form on file with the school. This form can be completed by a parent when the medication is delivered to the school.
Please list all persons authorized by you to pick up your child from camp should you be unable to do so. If an individual who is not listed will be picking up your child, please call the school to let the director know that you are authorizing the pick up.
Authorized Individual

Full NameRelationship to child
Full NameRelationship to child
2026 LIABILITY AND MEDICAL RELEASE:

This is a signed agreement stating that I, the parent or guardian, of Child's name * , will not hold any of the staff responsible financially or otherwise for any accidents or mishaps that may occur while my child is attending the Peas in a Pod program.

If emergency medical treatment is required for my child, and I cannot be reached before treatment is considered necessary, I grant permission for medical treatment to be obtained by the staff. The decision that treatment is necessary will be based on the opinion of a licensed physician.

I agree to notify the staff if there are any changes in my child’s medical condition or medication list. I also confirm that my child is up to date on all immunizations Signature* Date
- A non-refundable Registration Fee of $50 is required to hold your camp choices along with this form. This fee covers all camp weeks.
- You will be informed as to which camps are available for your child, and invoiced for tuition upon receipt of registration.
- Make checks payable to Peas in a Pod, pay via Brightwheel, with 3% svc chg, or by Venmo.
- After submitting this form, we will confirm registration using the contact information provided.
Should be Empty: