Summer Camp Sign-Up Form

*Must be 3 years old and up! (and potty trained)

Camper's Full Name

Age

Birthdate

Month

Day

Year

Email

Parent/Guardian Full Name

Parent/Guardian Phone

Street Address

City/State/Zip

EMERGENCY CONTACT

Name

Relationship

Phone

Family Doctor

Phone

PLEASE SELECT ALL THAT APPLY TO YOU

If you want to attend on a day rate (not weekly), please tell us which day(s) you would like to attend

Half Day or Full Day?

Half

Full

Extended Camp Care?

No, I will not need extended care

Yes, I will need extended care

If you NEED extended care, select which care you need, or both

BEFORE Camp Care: 8am-9am ($20 each 1/2 hour)

AFTER Camp Care: 3pm-4pm ($20 each 1/2 hour)

Please list any allergies and/or specific medical considerations. If none, put N/A:

PAYMENT METHOD

Please note: A $100 non-refundable deposit per child, per week is due with registration. The remaining payment is due ONE WEEK prior to your camp date. $50 non-refundable for day rate.

Charge My:

MC

Visa

AMEX

DISC

Credit Card Number

Expiration

CVV

Signature (as shown on cc)

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CC Mailing Address