Preschool Summer Camp Enrollment Form

Preschool Summer Camp Enrollment Form
Camper's Information
Camper's Name

First NameLast Name
Age
Gender
Date of Birth

MonthDayYear
Date
Email
example@example.com
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School Name
Camper's Photo (Optional)

Browse Files

Cancelof
Parent/Guardian Information
- The parents/guardian listed below will be the authorized person to pick-up the child after the camp.
- The parents/guardian listed below will also be the primary emergency contact person.
Name

First NameLast Name
Relation
Phone Number

Area CodePhone Number
Name

First NameLast Name
Relation
Phone Number

Area CodePhone Number
Medical Information
Does the child have any allergies? If yes, please list them below:
Does the child have any previous injuries? If yes, please explain them below:
Does the child have any current medical conditions? If yes, please list them below:
Does the child takes any medication? If yes, please list them below and explain its purpose:
Payment Details
Registration Fee
prevnext( X )
Week 1$220.00
June 15-18, 2026

Week 2$275.00
July 20-24, 2026

Week 3$275.00
July 27-July 31, 2026

Pay by CheckFree
If you would prefer to pay by check, click only here and checkout. Then contact office@mvpconline.org to report which weeks your child will attend and to coordinate payment.

Subtotal $0.00Tax $0.00Total $0.00
Authorization
- I, the parent/guardian of this camper gives authority to the staff of this camp to apply judgment in regards to medical assistance in the event of an accident, injury, or illness if the emergency contact person cannot be reached. I authorized first aid, medical/surgical diagnosis, and treatment which may deem necessary.
- I released the organizers, coaches, staff, or managers of this camp for any responsibility in case of accident, illness, or injury during my child's enrollment.
- I confirm that all information given in this form is true, complete, and accurate.
- I understand that this camp is exempt from licensure under VA code Section 22.1-289.030 B.3
Parent/Guardian Signature
Payment Methods

Fastlane Checkout

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

Contact Info

Payment Info
Should be Empty:

Preschool Summer Camp Enrollment Form

Camper's Information

Parent/Guardian Information

Medical Information

Payment Details

Registration Fee

Authorization

Payment Methods