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Overnight Camp Registration
Please enable JavaScript in your browser to complete this form.
Child's Full Name
*
First
Last
Age
*
Grade Level
*
School (Optional)
Pronouns(Optional)
Parent/Guardian Name
*
First
Last
Email Address
*
Phone Number
*
(xxx) xxx - xxxx
Emergency Contact Name
*
First
Last
Emergency Phone Number
*
(xxx) xxx - xxxx
Camp Session Selection
*
Overnight Camp — Second Saturday in July
I need more information
Select Session
School Accessibility Camp
Allergies or Dietary Restrictions
*
Medical Conditions or Medication
*
Accessibility Needs
*
Emergency Instructions Permissions
*
Participation Concent
*
I consent to my child’s participation in the program
I authorize emergency medical treatment if needed
Emergency Medical
I give permission for my child to participate in all program activities
I authorize staff to seek emergency medical care if I cannot be reached
Photo/Video Consent
I give permission for my child to be photographed or recorded for program documentation and promotional use
Will your Child need transportation?
*
Yes
No
Maybe
Are you requesting financial assistance?
*
Yes
No
Maybe
If yes, please explain
*
If no or maybe, put N/A
Additional Notes
Submit
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