25' Fall Break Camp

25' Fall Break Camp Days Only Registration

Oct. 13-14 2025
CHILD INFORMATION:
Child Name*

First NameLast Name
Child Name

First NameLast Name
Birth Date*

MonthDayYear
Grade*
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
Fall Break Options: Invoice sent separtely via email Cost: $60 per day AfterSchool Campers $30 per day*

Oct 13Oct 14
MEDICAL INFORMATION
Medical/Allergies Concerns
Signature*

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25' Fall Break Camp Days Only Registration