CYC Summer Camp Registration
Please complete the registration form to reserve your child's spot for camp and submit the non-refundable registration fee.
Camper's Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email Address
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Does the camper have any allergies or medical conditions?
*
What session(s) are you registering for?
*
Session 1 June 22 - July 3
Session 2 July 6 - July 17
Session 3 July 20 - July 31
Registration Fee
*
prev
next
( X )
Registration Fee
One time non-refundable registration fee
$25.00
$
25.00
Quantity
1
2
3
4
5
6
7
8
9
10
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Register
Should be Empty: