Clone of Day Camp Registration Form

C.A.P.S. Camp Registration Form

These forms are required for your child/children to attend camp. Camp is for ages 7-12.
Camper's Information
Member ID
Camper Name*
Nickname
Date of Birth*

MonthDayYear
Gender*
Age
NOTE - Children need to be between the age of 7 and 12 to participate in this day camp. Parents must provide proof of age for application approval. Limited slots available on a first-come, first-serve basis.
School in 2024/25*
Entering Grade in 2024/25*
Please provide any information that you think is important or may affect the camper's ability to fully participate in the camp program.

Parents' Information

Parent/Guardian 1
Parent/Guardian 1*

First NameLast Name
Relationship to Child*
E-mail*
example@example.com
Cell Phone*
Home Phone*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Work/School Name*
Or enter N/A if not applicable
Parent's Work/School Phone
Parent's Work/School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Where would you like to be reached while your child is at camp?*

Cell PhoneWork PhoneHome Phone
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Parent/Guardian 2
Parent/Guardian 2

First NameLast Name
Relationship to Child
E-mail
example@example.com
Cell Phone
Home Phone
Home Address Same as Parent/Guardian 1?

Yes
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Work/School Name
Or enter N/A if not applicable
Parent's Work/School Phone
Parent's Work/School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Where would parent/guardian 2 like to be reached while your child is at camp?

Cell PhoneWork PhoneHome Phone

Emergency Contacts/Authorized Pickup

Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be within one hour of The ARK/home, able to take responsibility for the child in case the parent/guardian cannot be contacted and should be at least 18 years of age. The first emergency contact must live no more than 1 hour away and be over the age of 18.
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Emergency Contact #1
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Secondary Phone Number*
Relationship to Child*
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Emergency Contact #2
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number
Secondary Phone Number
Relationship to Child

Payment and Statement of Understanding
The ARK has permission to secure emergency transportation for my child in the event of an illness or injury which requires emergency treatment. The emergency transportation service will determine the facility to which my child will be transported.*
Type first and last name above to consent
Sign Document*
Date Signed*

MonthDayYear
Camp Director Name and Contact Info
LINK TO PAY FOR REGISTRATION - Be sure to scan the bar code prior to hitting the submit button.
Should be Empty:

C.A.P.S. Camp Registration Form