Summer Camp Interest Form

Camp Registering For:
How many days per week?
 5 days
 4 days
 3 days
Child's Full Name (First, MI, Last):
Child's Date of Birth
Child's Age:
Grade Completed for 2019-2020 School Year:
Parent/Guardian's Full Name:
Parent/Guardian's Date of Birth:
Relationship to Child:
Parent/Guardian's Email Address:
Parent/Guardian's Full Mailing Address:
Home Phone Number:
Work Phone Number:
Cell Phone Number:
Person(s) Designated whom child can be released to (name and phone number):