Summer Camp Registration

Splatter & Sprout Summer Camp Registration
Child's Name

First NameLast Name
Date of Birth

MonthDayYear
Date
***Medical Information***
*Allergies (food, medication, insect bites etc.)
Allergies

*Medical Conditions (asthma, diabetes etc.)
Medical Conditions
Child 1: Pick Your Camps! Bundle 3 or more and save!
Age Group and Time:
Child 2 Name

First NameLast Name
Date of Birth

MonthDayYear
Date
***Medical Information***
*Allergies (food, medication, insect bites etc.)
Allergies

*Medical Conditions (asthma, diabetes etc.)
Medical Conditions
Child 2: Pick Your Camps! Bundle 3 or more and save!
Age Group and Time:
Child 3 Name

First NameLast Name
Date of Birth

MonthDayYear
Date
***Medical Information***
*Allergies (food, medication, insect bites etc.)
Allergies

*Medical Conditions (asthma, diabetes etc.)
Medical Conditions
Child 3: Pick Your Camps! Bundle 3 or more and save!
Age Group and Time:
Parent / Guardian Name

First NameLast Name
Phone #
Please enter a valid phone number.Format: (000) 000-0000.
Email (Invoice will be sent to this email address.)
example@example.com
Address

Street Address

Street Address 2

CityState

Zip Code
Parent / Guardian Name

First NameLast Name
Phone #
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState

Zip Code
***Emergency Contact (Other than parent/guardian)***
First Name   Last Name      Phone Number

First Name   Last Name      Phone Number
***Authorized Pick-Up Persons***
First Name Last Name Phone Number

First Name Last Name Phone Number
I understand and agree that pickup is no later then the scheduled pickup time. A late fee of $10 will be charged for every 10 minutes after the scheduled pick up time.
Invoices will be sent to the email address listed above for the first parent and will include all camps selected for the participant(s). Please note that space in each camp is limited. A participant’s spot will be confirmed once full payment has been received. We appreciate your prompt payment to help secure your child’s place in the selected camps.
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Splatter & Sprout Summer Camp Registration