Register Below to Join us this Summer!

Parent/Guardian 1 Name *

First Name

Last Name

Parent/Guardian 1 Phone Number *

(###)

###

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Parent/Guardian 2 Name

First Name

Last Name

Parent/Guardian 2 Phone Number

(###)

###

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I'm registering for *

Select all that apply

July 7 – 18

July 28 – August 8

Camper 1 Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Camper 2 Name

First Name

Last Name

Date of Birth

MM

DD

YYYY

Camper 3 Name

First Name

Last Name

Date of Birth

MM

DD

YYYY

Additional Campers?

Yes

Emergency Contact 1 Name *

First Name

Last Name

Phone Number

(###)

###

####

Emergency Contact 2 Name

First Name

Last Name

Phone Number *

(###)

###

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Authorized Pickup Adult *

Please Note: Name on registration must match name on ID.

First Name

Last Name

Authorized Pickup Adult

Please Note: Name on registration must match name on ID.

First Name

Last Name

Authorized Pickup Adult

Please Note: Name on registration must match name on ID.

First Name

Last Name

Photo/Video Permission *

Yes, I give permission for my child to be photographed/video recorded for program use

No, I do not give permission

I have read and agree to the summer camp policies and liability waiver *

Yes

Not Yet

I understand that my registration is not complete until payment is received *

Yes