Elk Grove Kids Camp Online Registration

Registration

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Welcome to Elk Grove Kids Camp! Please complete the following registration form to enroll in camp. Discounts for Early Bird Pricing will be adjusted by the Administrator after you submit your registration. Please allow up to 48 hours for payment to be processed.

* denotes required fields

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Alternate Emergency Contact(s) Name & Phone (will contact primary contacts first with an emergency)*

Physican's Name & Phone *

Dentist's Name & Phone*

Contact #1

MOTHER’S/GUARDIAN’S/MOTHER’S DOMESTIC PARTNER’S NAME First Name*

Last Name *

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

Confirm Portal Account Password

Contact #2

FATHER’S/GUARDIAN’S/FATHER’S DOMESTIC PARTNER’S NAME First Name*

Last Name*

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

School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)*

Medications (Leave blank if NONE)*

Person Authorized for Pick Up

Persons Authorized for Pick Up

Person Authorized for Pick Up

Click only on the days you are wanting to attend.

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)*

Medications (Leave blank if NONE)*

Person Authorized for Pick Up

Persons Authorized for Pick Up

Person Authorized for Pick Up

Click only on the days you are wanting to attend.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)*

Medications (Leave blank if NONE)*

Person Authorized for Pick Up

Persons Authorized for Pick Up

Person Authorized for Pick Up

Click only on the days you are wanting to attend.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)*

Medications (Leave blank if NONE)*

Person Authorized for Pick Up

Persons Authorized for Pick Up

Person Authorized for Pick Up

Click only on the days you are wanting to attend.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Grade Level*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)*

Medications (Leave blank if NONE)*

Person Authorized for Pick Up

Persons Authorized for Pick Up

Person Authorized for Pick Up

Click only on the days you are wanting to attend.

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Credit Card

Card Number *

Exp Month *

Exp Year *

Card Nickname

Name as it appears on card *

Address Line 1

Address Line 2

City

State

Zip*

Registration

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)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

Required Policies

(Show-Hide Details)