2024 Summer Camp Registration Form

Camper's First Name:

Camper's Last Name:

Date of birth:

Tell Us Which Weeks You're Interested In Signing Up?
Week 1
(June 10-14) Week 2
(June 17-21) Week 3
(June 24-28) Week 4
(July 1-5) Week 5
(July 8-12)

Camper's Current Age:

Food allergies?

Any medical conditions?

Home street address:

Unit/Apt:

City:

State:

Zip:

Home Phone:

Mother's cellphone:

Father's cellphone

Mother's first name:

Mother's last name:

Mother's email address:

Mother's occupation:

Father's first name:

Father's last name:

Father's email address:

Father's occupation:

Emergency Contact Name:

Emergency Contact Phone:

Camper's Insurance Career:

Camper's Insurance Number: