Registration Form

Weekly Rate - $265 per week.
Daily Rate - $75 per day. Daily enrollment is limited to a minimum of four days during the summer.
There is a one time registration fee of $25.

Required Information

Camper's Information

Camper #1
First and Last Name
Age
Birth Date
School
Entering Grade
T-shirt Size

One time registration fee - $25 Only applies to first camper registration of the year.

Weekly Camper
for the following full weeks:

	6/15 – 6/19		6/22 – 6/26		6/29 – 7/3		7/6 – 7/10
	7/13 – 7/17		7/20 – 7/24		7/27 – 7/31		8/3 – 8/7

Daily Camper
Day camper only? How many days total?
Day camper dates:

Mom and Dad's Information

Mom's Name
Dad's Name
Name on credit card

Home Phone
Cell Phone
Other Phone

Home Address
City
State
Zip
Email
Confirm Email