Camp Enrollment Form

Summer Camp Enrollment Form

Child Information

First Name *

Last Name *

Birth Date *

Month

Day

Year

Gender *

What name would you like us to use when addressing your child?

Please select which weeks you would like to register for: *

Will your child be attending full or half days? *

Getting to know your child

How would you describe your child? *

Does your child separate easily? *

What school does your child currently attend? *

Which school will s/he be attending for the next school year? *

Parent 1

First Name *

Last Name *

Street Address *

City *

State/Province *

ZIP Code *

Phone Number *

Email *

Parent 2

First Name

Last Name

Phone Number

Additional Comments

Non-Refundable Deposit $