ONLINE REGISTRATION

Registrants must complete the online registration below.  You will be directed to secure checkout for online payments.

All Fields Are Required - Enter "NA" if Not Applicable

Your Email:


Camper
First Name:



Camper Last
Name:



  Male          Female

Birthday:
(xx/xx/xx)


Age:

As of June 1
Grade:

Entering Fall 2010

Address:





City:


State:


Zip Code:


T-Shirt Size:

Mother's Name:



Home Phone:


Employer:


Work Phone:


Cell Phone:


Email:


Father's Name:



Home Phone:


Employer:


Work Phone:


Cell Phone:


Email:


2010 Summer Camp Session Dates:






Scroll for all selections.
*NOTE: Number of campers accepted these weeks are VERY limited. Please verify with your child’s school calendar before registering for these weeks

Before & After Care:

This care is provided at no extra cost to you.  Estimated times must be provided for proper staffing.

Drop-Off Time:


Pick-Up Time:




Please list below the full name and cell phone number of all person(s) authorized to pickup your child
(in addition to parent/guardian listed above)
:


Comments and/or Special Instructions:



Terms Of Enrollment Agreement (Required)


By checking the box below I represent that I have read and understand the Terms Of Enrollment and that each parent or guardian agrees to its terms and conditions. 

I also understand that I must complete and submit a Health History Form and Immunization Record for each Camper.  Registration is complete upon receipt of deposit payment.


Yes, I agree       






 
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