Name of Camper (Last name, First name)*:

Gender*: Select One Male Female

Birth Date (MM/DD/YYYY)*:

What grade did your child recently complete?*: Select One 4 year old Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th

T-Shirt Size*: Select One Youth Small Youth Medium Youth Large Youth Extra Large Adult Small Adult Medium Adult Large Adult Extra Large

School:

Billing Name*:

Address*:
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Home Phone Number(s) (with area code):

Work Phone Number(s) (with area code):

Cell Phone Number(s) (with area code):

Email Address*:

Alternate Contact*:

Alternate Contact Phone (with area code)*:

Please choose the weeks in which you would like to enroll.

Week 1 (6/14-6/18)

   Lunches: None 1 2 3 4 5

Before Care (7:00am - 8:30am):

Week 1

Week 5

Week 8

After Care (3:00pm - 5:30pm):

Week 1

Week 5

Week 8

If this is the 2nd, 3rd, etc. child from the same family, check here.