Parent Name *

First Name

Last Name

Parent Phone

(###)

###

####

Child’s Name

First Name

Last Name

Child’s Gender

Boy

Girl

Child’sBirth Date

MM

DD

YYYY

I’m wanting to register my child for the following camp dates: *

A 2 week purchase minimum is required. You may select as many weeks as you’d like. A discount is given when you select 4 weeks at once.

June 2 - 6

June 9 - 13

June 16 - 20

June 23 - 27

June 30 - July 4

July 7 - 11

July 14 - 18

July 21 - 25

July 28 - Aug 1

Can your child swim independently in all depths of water? *

This is an absolute must to join us at camp. We will be swimming in the pool daily, life guards will be at the pool watching but independent swimming is a non negotiable for the safety of all campers.

Yes

1 Emergency Contact Name

First Name

Last Name

1 Emergency Contact Number

(###)

###

####

2 Emergency Contact Name

First Name

Last Name

2 Emergency Contact Number

(###)

###

####