Camp Summit Online Registration

Registration

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Welcome to Camp Summit! Camp Summit enrollment is available to students ages 4 to 10 years old. This year, we will offer extended care from 8:00 am to 5:00 pm for an extra fee. Please read the Camp Summit Brochure on our website thoroughly before completing the registration process. There is a $75/week non-refundable registration fee is due at the time of registration. The fee will be applied to the balance for each session attended.

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Referral Information

How did you hear about us?*

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info (Not Contact #1 or #2)*

Health Insurance Carrier*

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Minimum number of characters is 5

Confirm Portal Account Password

Minimum number of characters is 5

Contact #2

Contact #2 First Name*

Last Name*

Type*

How can we contact you?

Home Phone

Work #

Cell # *

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Grade Level*

Allergies*

Medications (Leave blank if NONE)

Primary Doctor*

Immunization Notes*

PLEASE REGISTER FOR THE WEEKS YOUR CHILD WILL ATTEND SUMMER CAMP BY CLICKING ON THE 'SELECT CLASS' LINK BELOW. YOU WILL ALSO BE ABLE TO REGISTER FOR EXTENDED CARE VIA THIS LINK. (SELECT BOTH REGULAR AND EXTENDED WHEN ENROLLING FOR EXTENDED CARE.)

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Grade Level*

Allergies*

Medications (Leave blank if NONE)

Primary Doctor*

Immunization Notes*

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Grade Level*

Allergies*

Medications (Leave blank if NONE)

Primary Doctor*

Immunization Notes*

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Grade Level*

Allergies*

Medications (Leave blank if NONE)

Primary Doctor*

Immunization Notes*

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Grade Level*

Allergies*

Medications (Leave blank if NONE)

Primary Doctor*

Immunization Notes*

Enroll in Classes

Select Class *

Add Another Student

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Comments

Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

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Student #2 (Show-Hide Details)

Additional Info

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Student #3 (Show-Hide Details)

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Student #4 (Show-Hide Details)

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Student #5 (Show-Hide Details)

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Enroll in Classes

Required Policies

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I Agree to All of the Above

Questions or Concerns

Payment Information

Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

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Student #4 (Show-Hide Details)

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Student #5 (Show-Hide Details)

Additional Info

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I Agree to All of the Above

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