Summer Camp Registration
Wilson's Rising Stars Youth Academy
What camp are you registering your child for?
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Main Street Multi-Purpose located at (101 W 48th Street, Jacksonville, FL 32208)
Westside Multi-Purpose (7945 103rd Street, Jacksonville FL 32210)
Southside Multipurpose located at (2214 University Blvd S, Jacksonville, FL 32216)
Child's Name
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First Name
Last Name
Suffix
2nd Child's Name
First Name
Last Name
Suffix
3rd Child's Name
First Name
Last Name
Suffix
Birthday child 1
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Month
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Day
Year
Date
Birthday child 2
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Month
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Day
Year
Date
Birthday child 3
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Month
-
Day
Year
Date
What grade will your child be in 2026/2027? (We will introduce some academics for your child's next school year once per week)
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Age
Age Child 2
Age Child 2
2nd Child. What grade will your child be in 2026/2027? (We will introduce some academics for your child's next school year once per week)
3rd Child. What grade will your child be in 2026/2027? (We will introduce some academics for your child's next school year once per week)
Shirt Size
*
Please Select
xs youth
s youth
m youth
L youth
XL youth
S Adult
M Adult
L Adult
XL Adult
XXL Adult
2nd Child Shirt Size
Please Select
xs youth
s youth
m youth
L youth
XL youth
S Adult
M Adult
L Adult
XL Adult
XXL Adult
3rd Child Shirt Size
Please Select
xs youth
s youth
m youth
L youth
XL youth
S Adult
M Adult
L Adult
XL Adult
XXL Adult
Mother/Father/Guardian Name
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First Name
Last Name
Mother/Father/Guardian Name
First Name
Last Name
E-mail
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Phone Number
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Area Code
Phone Number
Does your child have any special needs, medical conditions, medications or allergies? if yes, please explain. (If more than one child write the name and the special need next to the name.)
Camp FEES. I understand that I will pay the following fees due every Friday, which is for camp for the following week. The first week's payment is due on or before the 1st day of camp. (No refunds for unused days or weeks of camp)
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$95 per week 1 child (Does not include extended hours)
$75 per week siblings (does not include extended hours)
$285 Every 3 Weeks for 1 child (Save for the summer)(Does not include extended hours)
$775 Entire Camp Fee Paid Upfront (Save for the entire summer, this fee does not include extended hours)
Other
If a different Fee was discussed, please write the amount here.
Extended hours fees (varies by location, extended hours fee will be added to your weekly fee)(There will be a $10 off per service for siblings).
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$20 per week (Before, 6:30am @48th & Main, 7:00am-8:00am 103rd)
$20 per week (After 4:00pm-6:00pm)
$40 per week Before & After
$10 per week (Sibling Discount) (Before, 6:30am @48th & Main, 7:00am-8:00am 103rd)
Extended hours are not needed
REGISTRATION FEE ( Registration fee pays for camp supplies, tshirt,) (Fee may be paid with link below, Registration Fee is Non-refundable)
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$85 Registration (April 1st-May 31)
$100 Late Registration (Beginning May 16th)
ACTIVITY FEE (Field Trips are optional) (Activity Fee is Non-refundable, as it will be used to pre-pay for trips/buses, etc.) (The activity Fee Covers all field trips, special activities, special guests) Field trips are additional fee & we will send out permission slip form for trips.
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I understand
How do you wish to pay activity fee?
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$115 Every 3 Weeks
$80 due at start of camp, then $35 each week for the next 7 weeks
$300 Paid At Start of Camp
$105 Every 3 Weeks & pay the first 3 Weeks with this registration form
$40 weekly
I choose to pay for field trips on a trip by trip basis. (With this option you're required to pay $50 for the summer for bus fees to pool & Park, but each field trip is optional & you will be sent permission slips for each field trip.)
Any additional comments such as promotions we ran/etc
Did anyone refer you to camp, if so... who? Or where did you hear about our camp?
Please type your full name in box, then sign below box.
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Summer Camp Registration, please select one that applies to you.
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Registration Fee
$50.00
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50.00
Per child $50
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Subtotal
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Tax
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Total
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Payment Methods
Credit Card
Apple Pay
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Google Pay
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Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
Afterpay
After submitting the form, you will be redirected to Afterpay to complete the payment.
Signature
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