Register Online 2018

Register Online
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Register my child Request information
Request information
E-mail *

Confirmation Email
If new to us, where did you hear about our summer camp?
Please let us know what you would like to know about our summer camp?
Parent and contact information
Father's name

First Name Last Name
Father's Phone Number

- Area Code Phone Number
Mother's name

First Name Last Name
Mother's Phone Number

- Area Code Phone Number
E-mail *

Confirmation Email
Child 1 Information
Name of Camper
Date of birth

Month Day Year
Age
Sex

Girl Boy
Select Weeks

Week 1 (June 25-29) Week 2 (July 2-6) Week 3 (July 9-13) Week 4 (July 16-20) Week 5 (July 23-27)
Grade enrolled in
Current School
Pediatrician's name
Pediatrician's phone number
Does your child have health problems or allergies? Please be specific
Medical insurance

Yes No
Child 2 Information
Name of Camper
Date of birth

Month Day Year
Age
Sex

Girl Boy
Select Weeks

Week 1 (June 25-29) Week 2 (July 2-6) Week 3 (July 9-13) Week 4 (July 16-20) Week 5 (July 23-27)
Grade enrolled in
Current School
Pediatrician's name
Pediatrician's phone number
Does your child have health problems or allergies? Please be specific
Medical insurance

Yes No
Child 3 Information
Name of Camper
Date of birth

Month Day Year
Age
Sex

Girl Boy
Select Weeks

Week 1 (June 25-29) Week 2 (July 2-6) Week 3 (July 9-13) Week 4 (July 16-20) Week 5 (July 23-27)
Grade enrolled in
Current School
Pediatrician's name
Pediatrician's phone number
Does your child have health problems or allergies? Please be specific
Medical insurance

Yes No
Should be Empty: