Summer Camp Registration Form

BMN Summer Camp Registration Form
We are excited for a fun and engaging summer camp season!

At Bully Me Now, we strive to create a safe, respectful, and positive environment for all campers, staff, and families. Proper behavior and communication are required from all participants.

Parent, please note that our camp hours are 7:30 a.m. to 6:00 p.m., Monday through Friday. Please pack a lunch, water bottle, and snacks for your child each day of camp.

Field Trips are organized by age group to ensure activities are appropriate, safe, and enjoyable for everyone. Each age group participates in one field trip per week, allowing campers to explore new places and experiences with peers their own age. Field trips are optional and require an additional cost. For safety and planning purposes, detailed information and sign-up opportunities will be provided closer to the start of summer so families can review trip details and register in advance.

Contact us at the below for additional information requests:

Bully Me Now MMA
bullymenowmma@gmail.com
386-299-7493
Student Information
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information

For minors (below 18 years of age)
Parent/Guardian Name

First NameLast Name
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Emergency Contact

First NameLast Name
Phone Number
Format: (000) 000-0000.
If your child has any physical, emotional, behavioral, or cognitive special needs, please detail below. You must contact Coach Vic or Miss Kacy before the start of camp to discuss necessary arrangements.

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Week One: June 1st- 5th
3 & 5 Day Pricing Applied via Quantity Selection

$40.00 Quantity



Week Two: June 8th- 12th
3 & 5 Day Pricing Applied via Quantity Selection

$40.00 Quantity



Week Three: June 15th- 19th
3 & 5 Day Pricing Applied via Quantity Selection

$40.00 Quantity



Week Four: June 22nd- 26th
3 & 5 Day Pricing Applied via Quantity Selection

$40.00 Quantity



Week Five: June 29th- July 3rd
3 & 5 Day Pricing Applied via Quantity Selection

$40.00 Quantity



Week Six: July 6th- 10th
3 & 5 Day Pricing Applied via Quantity Selection

$40.00 Quantity



Week Seven: July 13th- 17th
3 & 5 Day Pricing Applied via Quantity Selection

$40.00 Quantity



Week Eight: July 20th- 24th
3 & 5 Day Pricing Applied via Quantity Selection

$40.00 Quantity



Week Nine: July 27th- 31st
3 & 5 Day Pricing Applied via Quantity Selection

$40.00 Quantity



Week Ten: August 3rd- 7th
3 & 5 Day Pricing Applied via Quantity Selection

$40.00 Quantity



Total

$0.00
Summer Camp Rates

Daily Rate: $40 3 Days per Week: $100 5 Days per Week $165
If registering for fewer than 5 days, please indicate the specific days your child will attend.
Confirmation & Payment
Signature
Date Signed

MonthDayYear
Date
Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
Should be Empty:

BMN Summer Camp Registration Form

Student Information

Parent/Guardian Information

Summer Camp Rates

Confirmation & Payment

Payment Methods