Camp Registration

1. Child's Information
Child 1*
First NameLast Name
Birth Date*
MonthDayYear
Gender*
MaleFemale
Weeks*
Week 1 (from July 5)Week 2 (from July 11)Week 3 (from July 18)Week 4 (from July 25)Full Summer
Child 2
First NameLast Name
Birth Date
MonthDayYear
Gender
MaleFemale
Weeks
Week 1 (from July 5)Week 2 (from July 11)Week 3 (from July 18)Week 4 (from July 25)Full Summer
If you have additional children, please submit a second registration form.
2. Parents' Information
Phone Number*
Area CodePhone Number
Parent 1 Name*
First NameLast Name
Cell Phone
Area CodePhone Number
Work Phone
Area CodePhone Number
E-mail*
Primary email
Parent 2 Name
First NameLast Name
Cell Phone
Area CodePhone Number
Work Phone
Area CodePhone Number
E-mail
Primary email
How did you hear about us?
3. Emergency Information
Emergency Contact*
First NameLast Name
Phone Number*
Area CodePhone Number
Relationship*
Pediatrician
First NameLast Name
Phone Number
Area CodePhone Number
Insurance
4. Payment Agreement
A $99 Non-Refundable Deposit will be charged at registration. The other payments will be charged before camp starts.

Payment*

Credit Card

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Total Amount to pay for Registration for Camp 2022*
$99$198
Total
$0.00
5. Agreement
I am signing up my child for camp. I accept full financial responsibility for on time payment.
I give my child permission to attend all trips and receive medical care in the case of emergency.
I give permission to photograph and videotape my children to use for promotion (without their names).
Comments & Allergy Information
Should be Empty:

This page uses TLS encryption to keep your data secure.

1. Child's Information