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Summer Camp Registration Form
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Parent's Name
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Last
Parent's Cell Phone Number
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Email
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Home Address
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City
State
Zip Code
Country
Emergency Contact
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First
Last
Relationship to Child(ren)
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Emergency Contact Number
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How many weeks will you be enrolling your child(ren)
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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
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First
Last
(1) Age
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(2) Child's Name
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First
Last
(2) Age
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(3) Child's Name
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First
Last
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(3) Age
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(4) Child's Name
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First
Last
(4) Age
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Allergies & Other Concerns
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Please inform us if your child(ren) have allergies or if there is anything else you feel we should know about your child.
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