Clone of 2025 Summer Camp Registration Form

Parents' Information

Parent/Guardian 1
Parent/Guardian 1*

First NameLast Name
Relationship to Child*
E-mail*
example@example.com
Cell 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
Where would you like to be reached while your child is at camp?*

Cell PhoneWork Phone
Parent's Information (if applicable)

Parent/Guardian 2
Parent/Guardian 2

First NameLast Name
Relationship to Child
E-mail
example@example.com
Cell 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
Where would parent/guardian 2 like to be reached while your child is at camp?

Cell PhoneWork Phone

Emergency Contacts/Authorized Pickup

Parents should not 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 center/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.
Emergency Contact Information

Emergency Contact #1
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Relationship to Child*
Emergency Contact Information

Emergency Contact #2
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

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

Allergies and Restrictions
Allergies? Check all that apply.

FoodMedicationEnvironmental
Please list and explain any allergies

0/250
Does your child’s allergy/allergies require child care staff to monitor child for symptoms, take action if a reaction occurs, or give emergency medication to your child?

YesNo
Does your child have a special health or medical condition?

YesNo
Please explain

0/150
Does the special health or medical condition require child care staff to perform a procedure, or perform child specific care such as: to monitor your child for symptoms or administer medication during child care hours?

YesNo

Payment Options

Please choose which type of payment option you would prefer for summer camp. Payment(s) can be made with check or cash to avoid Quickbook fees.
Would you prefer one invoice for the entire summer or a monthly invoice based upon the weeks your camper is enrolled?*

One invoice (due before the start of summer camp)Monthly invoices (due before the 3rd of the month)
Summer Camp Registration
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2026 Summer Camp Registration
Registration, materials, and enrichment fee for Summer Camp 2026

$75.00

Total

$0.00

Pay with Credit Card

Allergies and Restrictions