Registration

3 openings left in this event!

Please make sure to sign in to your Parental Portal to Select your Class(es) after filling out the Registration Form.

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 (Not Contact #1 or #2)*

Add New Student #1:

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	Student's First Name: *	Last Name: *
	Student Gender: *	Birth Date: * (format=mm/dd/yyyy)
	School:*	Grade Level Entering in the Fall:*
	Disabilities:*
	Allergies:*
	Medications:*
	Primary Doctor:*
	Have you attended camp before?:
	Do you have any fears?:
	Can you swim?:
	How do you feel about Camp?:
	Campers Nickname (if applies):

Add New Student #2:

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Questions/Options:


Any medical conditions we should be aware of?*
Who will be picking your student up? List any possibilities. *
Please make sure to log in to your Parent Portal, after Registering, to pick which Summer Class(es) you want.

Additional Information:

Assumption of Risk/Release of Liability

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I've read the above and agree.

Payment/Make Up/ Refund Policies

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I've read the above and agree.

Enter your Full Name: