Please enter:
Child's Name | Birth Date | Gender | Describe any dietary requirements | Describe any allergies or medical concerns | ||
|---|---|---|---|---|---|---|
A | B | C | D | E | ||
1 | ||||||
2 | ||||||
3 | ||||||
4 | ||||||
5 |
Home Address
Address Line 1
Address Line 2
City/Town
State/Province
Zip/Postal Code
Parent/Guardian Name
First
Last
Relationship to child
Home Phone
Mobile Phone
Email Address
Employer
Work Phone
Please list two emergency contacts who can pick up your child/children other than parent/guardian.
Please enter:
Full Name | Phone Number | Relationship to child | ||
|---|---|---|---|---|
A | B | C | ||
1 | ||||
2 |
Member get 10% discount!
Please select the program that your child/children want to join:
Session | Program | Fees per week | Select | No. of Children | Subtotal | ||
|---|---|---|---|---|---|---|---|
A | B | C | D | E | F | ||
1 | Week 1 | Program A | $0.00 | ||||
2 | Week2 | Program B | $0.00 | ||||
3 | Week 3 | Program C | $0.00 | ||||
4 | Week 4 | Program D | $0.00 | ||||
5 | Week 5 | Program E | $0.00 | ||||
6 | Week 6 | Program F | $0.00 | ||||
7 | Week 7 | Program G | $0.00 | ||||
8 | Week 8 | Program H | $0.00 | ||||
9 | Week 9 | Program I | $0.00 | ||||
10 | Total Fees | $0.00 |
Are you a member? (If yes, please tick the box)
Membership ID#
Total Fees:
You get 10% discount.
I give permission for my child/children to participate in selected activities at camp.
Parent/Guardian Signature
To configure an element, select it on the form.