SummerCampForm

Summer Camp Registration Form

* Indicates required field

Parent's Name *

First

Last

Parent's Cell Phone Number *

Email *

Home Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency Contact *

First

Last

Relationship to Child(ren) *

Emergency Contact Number *

How many weeks will you be enrolling your child(ren) *

One Week ($85 per child) Two Weeks ($170 per child) Three Weeks ($255 per child) Four Week Program ($300 per child) Full Five Week Program ($375 per child)

(1) Child's Name *

First

Last

(1) Age *

(2) Child's Name *

First

Last

(2) Age *

(3) Child's Name *

First

Last

(3) Age *

(4) Child's Name *

First

Last

(4) Age *

Allergies & Other Concerns *

Submit