Online Registration 5778!

Please fill out the form below carefully.
When you press submit, you credit card will be charged.

Note: Please use a separate form for each child.

Camper Information:
Last Name* First name*
Address* City*
State* Zip*
Home Phone* Age*
Birthday* (secular) Grade Entering*
Shirt Size* (Click here for Size Chart)

       

Parent Information:

Mother's First Name* Email Address*
Work Phone
Cell Phone*
Father's First Name* Email Address*
Work Phone
Cell Phone*
       
Medical Information:
Insurance Company* Policy Number*
Doctor’s Name* Doctor's Phone Number*
Food Allergies Drug Allergies
Other Health Considerations
       
If/when parents are not available:
Emergency Contact #1: Name* Relationship* Phone*
Emergency Contact #2: Name* Relationship* Phone*
Would Like To Attend:
Full Summer
(June 26-August 9)
Session 1
(June 26-July 20)
Session 2
(July 23-August 9)
     
Weeks:
Week 1 (June 26-29) Week 2 (July 2-6) Week 3 (July 9-13)
Week 4 (July 16-20) Week 5 (July 23-27) Week 6 (July 30-August 3)
Week 7 (August 6-9)    

Click Here For Information Regarding Camp Fees

Payment Information:

Amount*:
$

Cardholder's First Name*
Cardholder's Last Name*
Billing Street Address*
Billing Zip*

Card Type*

Card Number*
Expiration Date*
Security Code*