Summer Camp

Registration Form

Please complete this form so we have all necessary information regarding your child. If you have two kids attending you only need to complete one form but include both kids info.

Camper's Full Name

Camper's Date of Birth

Camper's Current Grade Level ( K - 5 )

Camper 2 Full Name

Camper 2 Date of Birth

Camper 2 Current Grade Level ( K - 5 )

Primary Parents/Guardians Full Name

Primary Parent/Guardian Phone Numbers

Primary Parent/Guardian Email Address

Home Address (Street, City, State, Zip)

List all individuals (including parents/guardians) authorized to pick up the camper/s (First and Last name as on their ID)

Emergency Contact Name (Must be different from Primary Parent/Guardian)

Emergency Contact Phone Number

Emergency Contact Relationship to Camper/s