Summer Camp Enrollment Form

Free Girls Summer Camp Registration

July 7th - August 4, 2025 Monday-Thursday 9am-12pm One time Registration Fee of $25 due by July 11, 2025 Camp Site: 1018 Wallace street Phila, Pa 19123
CHILD INFORMATION:
Child Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade*
Nick Name*
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
MEDICAL INFORMATION
Physician Name

First NameLast Name
Phone Number
Medical Concerns: Such as Respiratory, Neurological, Mental, Physical restrictions.
Parent/ Legal Guardian Signature

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Free Girls Summer Camp Registration