Charger Pride Summer Camp Registration Form
Blythewood Middle School is offering extended enrichment opportunities for students during summer break. Students will participate in academic enrichment for their grade level. The enrichment activities will include Fitness/Wellness, Arts & Crafts, Weekly Field Trips and Math & ELA Academic Enrichment.

Registration Fee- $25 per child
Camp Hours: 7:30am-6:00pm
Cost: $120 per week (activities and field experience included)
District Employees $100 per week
$10 Sibling Discount Available
Summer Camp Dates: June 12th - August 4th (closed during the week of July 4th)
Rising 4th-8th graders (students will be grouped by age)

Summer Camp Program Directors:
Crystal Munson and Kirsten Baker
Phone: 803.691.6850, ext. 85401

Email address
Child 1- (First and Last Name)
Your answer
Child 1- Date of Birth
Your answer
Child 1- Grade
Child 1 - Age
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Child 2- (First and Last Name)
Your answer
Child 2 - Date of Birth
Your answer
Child 2- Grade
Child 2 - Age
Your answer
Child 3- (First and Last Name)
Your answer
Child 3- Date of Birth
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Child 3- Grade
Child 3 - Age
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Home Address- ( include the city, state and zip code)
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Name of the school that your child (children) will attend this fall.
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Parent/Guardian 1 ( First and Last Name)
Your answer
Parent/Guardian 1 ( Email Address)
Your answer
Parent/Guardian 1 ( Cell)
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Parent/Guardian 1 ( Work)
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Parent/Guardian 1 ( Employer - please include the company's address)
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Parent/Guardian 2 ( First and Last Name)
Your answer
Parent/Guardian 2 ( Email Address)
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Parent/Guardian 2 ( Cell)
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Parent/ Guardian 2 ( Work)
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Parent/Guardian 2 ( Employer - please include the company's address)
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Parent/Guardian 2 ( Employer - please include the company's address)
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Emergency Contact Name ( May not be the same as above Parent/Guardian)
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Emergency Contact (Cell)
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Emergency Contact (Work)
Emergency Contact Empoyer ( Please include the company's address)
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Additional Authorized Person for Pick- Up #1 Name (First and Last Name) and Phone Number
Your answer
Additional Authorized Person for Pick- Up #2 Name (First and Last Name) and Phone Number
Your answer
Additional Authorized Person for Pick- Up #3 Name (First and Last Name) and Phone Number
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Additional Authorized Person for Pick- Up #4 Name (First and Last Name) and Phone Number
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Select the weeks that your child (children) will attend camp. (Minimum of three weeks)
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