Summer Camp Registration Form

Summer Camp Registration Form

Please fill out the child's and parent's information, agree to the liability statement, and provide payment details to complete your registration.
Child's Full Name

First NameLast Name
Child's Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Child's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Child's Birthdate

MonthDayYear
Date
Child's Age
Parent/Guardian Full Name

First NameLast Name
Parent/Guardian Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Signature

Please sign below to acknowledge the liability waiver.

Summer Camp Registration Fee

Covers all activities and local travel for one child.

$200.00

Total

Credit Card

Apple Pay

Google Pay