2026 Eastside Express Registration and Payment Form

Eastside Express Summer Camp 2026

Join us June 22nd-August 7th from 8:30am-11:30am every Monday-Friday. Please only register one child at a time. ESX is open only to children ages 7-12. $35 per week. Minimum registration requirement of 3 weeks. All fees apply for absences (including behavioral), holidays, and camp closings due to inclement weather. Registration closes on May 31st or when spots are full, with a 50 youth maximum.
Child's Name*

First NameLast Name
Child's Date of Birth*

MonthDayYear
School/grade child will be attending this fall*
- Parent/Guardian #1*
  
  First NameLast Name
- Parent/Guardian #1 Phone*
- Address #1*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Parent/Guardian #2
  
  First NameLast Name
- Parent/Guardian #2 Phone
- Address #2
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Emergency Contact Name*
- Emergency Contact Phone*
- Doctor's Name
- Doctor's Phone
- Known allergies
- Preferred hospital
- Email #1*
  example@example.com
- Email #2 (optional)
  example@example.com
- Additional comments
- Signature*
  
  Clear
- Weeks Registering For:*
  prevnext( X )
  
  Week One (June 22nd- June 26th)
  Please select if you'd like your child to attend WEEK ONE.
  
  $35.00
  
  
  
  Week Two (June 29th- July 3rd)
  Please select if you'd like your child to attend WEEK TWO.
  
  $35.00
  
  
  
  Week Three (July 6th- July 10th)
  Please select if you'd like your child to attend WEEK THREE.
  
  $35.00
  
  
  
  Week Four (July 13th- July 17th)
  Please select if you'd like your child to attend WEEK FOUR.
  
  $35.00
  
  
  
  Week Five (July 20th-July 24th)
  Please select if you'd like your child to attend WEEK FIVE.
  
  $35.00
  
  
  
  Week Six (July 27th- July 31st)
  Please select if you'd like your child to attend WEEK SIX.
  
  $35.00
  
  
  
  Week Seven (August 3rd- August 7th)
  Please select if you'd like your child to attend WEEK SEVEN.
  
  $35.00
  
  
  
  Total
  
  $0.00
- Should be Empty:

Eastside Express Summer Camp 2026