Camper Information

First Name

Last Name

Sex

Birth Date

Grade

Age

Medical Concerns

First Name

Last Name

Sex

Birth Date

Grade

Age

Medical Concerns

First Name

Last Name

Sex

Birth Date

Grade

Age

Medical Concerns

Parent/ Guardian Contact Information

Relationship to Participants: *

Mother

Father

Guardian

Other Other

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Zip *

Phone

Alternate Phone

Email Address *

Camp Time: 8:00 AM - 5:30 PM - Full Day Session

Camp includes: Snacks/ Field Trips/ Summer Camp T- Shirt

Early Drop off and extended care is available upon request (Additional Cost will be applied at a rate of $10.00)
(Extra charges will apply when campers are picked up after 5:30 PM - $5.00 per minute)

Camp Schedule

Please pack a peanut free lunch for your child

Please sign below to accept the terms and reserve space for your child(ren).

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