Registration

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Backyard Camp-In Camp brings the outdoors inside for a day full of classic camp fun! Campers ages 4–12 will enjoy tent-building, camp-style games, indoor “campfires,” crafts, snacks, and storytelling—all in a cozy, safe setting. It’s all the adventure of camp without leaving the building! ** Students must bring a packed lunch **

Event:

Start Date/Time:

End Date/Time:

Fee per Student:

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)

Students entered below will be added to your family's account

Add New Student #1:

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	Student's First Name: *	Last Name: *
	Student Gender: *	Birth Date: * (format=mm/dd/yyyy)
	Student Email:
	School:	Grade Level:
	Disabilities (Leave blank if NONE):
	Allergies (Leave blank if NONE):
	Medications (Leave blank if NONE):
	Primary Doctor:

Additional Information: