Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Home Phone: Cell #: Work #:
Email:* (Emails are kept confidential)
Address: *
City: * State: * Zip: *
Students entered below will be added to your family's account
If you would like to make the payment in Cash please mark the box as YES and stop by BEFORE the camp date (3:30PM-6:00PM weekdays, 9:30AM-12:00NOON Weekends) to make the payment at the Pre-Paid price.
I understand that my child's picture may be used in promotional materials. If you do not want your child's picture or video taken please mark the box as NO.
Will you require your child to stay extra hours after 3:00PM? Please indicate how many extra hours you will require in the text box. 6:00PM Maximum. 1 hr=$5.00 Pre-Paid/$10.00 late pay
Additional Information:
Parental Consent
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I've read the above and agree.
Enter your Full Name: *   
Other Questions/Comments:
Credit Card Verification:
Card Number: *  
Name as it appears on card: *
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*