Registration

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Half-Day Summer Camp (Ages 4 & Up - 9 AM to 12 PM - $330 per week M,T,W,TH,F) Summer Luau Party: June 9th-13th Ninja Warrior: June 16th-20th Carnival/Circus: June 23rd-27th Rock ‘n’ Roll: July 7th-11th Under the Sea: July 14th-18th Mini Olympics: July 21st-25th

Event:

Start Date/Time:

End Date/Time:

Fee per Family:

Room:

* - denotes required fields

Family Information

	First Name:*	Last Name: *
	Type*
	Home Phone:	Cell #: Work #:
	Email:*	(Emails are kept confidential)

	Address: *
	City: *	State: * Zip: *
	Emergency Contact Info*

Additional Information:

Other Questions/Comments:

Credit Card Verification:

Card Number: *

Name as it appears on card: *

Nickname:

Card Expiration Month: *

Exp Year: *

Address Line 1:

Address Line 2:

City:

State: Zip:*