Second UP Summer Camp
Registration Form
Camper Information
Camper Name
First Name
Last Name
Parent's Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Date of Birth
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Information
Emergency Contact Name
First Name
Last Name
Relationship
Emergency Phone Number
-
Area Code
Phone Number
Medical Information
Please state if the camper has any allergies, illnesses or medical conditions.
Weeks you plan on attending
Week 1 June 6-12 Let's Go to Camp!
Week 2 June 15-19 Going on a Bear Hunt!
Week 3 June 22-26 Messy Science Fun
Week 4 June 29-July 3 America and Space Camp
Week 5 July6-10 Legos Everywhere
Week 6 July 13-17 Field Week (Sports & Games)
Week 7 July 20-24 Express Yourself (Messy Art)
Week 8 July 27-31 Messy Monster Fun!
Week 9 August 3-7 Bubbles, Bubbles, Everywhere
Week10 August 10-14 A Day at Our Beach Camp (Sand &Water Fun)
How many days do you think you will attend each week?
Please Select
One day
Two days
Three days
Four days
Five days
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Summer Camp Deposit
This deposit is non-refundable, but will be applied to your first day of summer camp.
$
25.00
Quantity
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Credit Card
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