Summer Camp Registration Form

Please fill out the following form for each child attending summer camp.

After submitting the form, you will be directed to purchase and pay the non-refundable camp deposit. Payments are due at the time of registration or your spot will not secured. The remaining balance is due the week before camp.

Child's Name*
First Last
Child's Date of Birth*
Program Date*
- June 18-22, 2018
- July 16-20, 2018
- August 13-17, 2018
Parent/Guardian Name*
First Last
Email*
Contact Phone (primary)*
Second Parent/Guardian Name*
First Last
Contact Phone (secondary)*
Address*
Street Address Address Line 2 City State ZIP Code
Any allergies?*
Comments
Any special accommodations?

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