Parent's Name *

First Name

Last Name

Parent's Phone # *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Child's Name *

First Name

Last Name

Child's Date of Birth *

MM

DD

YYYY

Consent to have child's picture taken during camp *

Yes, I consent to my child's picture being taken

I do not constent to my child's picture being taken

Please select which camp you would like to place your child into *

Ages 3-4 June 3rd - 7th: 2pm - 4pm

Ages 4-7 June 3rd - 7th: 11 AM - 4 PM

Ages 8-12 June 10th - 14th: 11 AM - 4 PM

Ages 13-17 June 17th - 21st: 11 AM - 4 PM