Summer Camp 2021 Registration

Camper Registration

* Indicates required field

Child's Name *

First

Last

Gender *

Male Female

Age *

Grade (rising) *

Child's Birthdate MM/DD/YYYY *

Allergies, medications, special needs, etc. *

T-Shirt Size *

Parent's Information

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Primary Phone Number *

Secondary Phone Number *

Work Phone Number *

Emergency Contact *

First

Last

Emergency Contact Phone Number *

Submit Registration (Payment Info On Next Screen)