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Panagia's Garden Camp Registration
Thank you registering for Panagia's Garden Camp! 

1) PLEASE FILL OUT THIS FORM SEPARATELY FOR EACH CAMPER IN ITS ENTIRETY. 

2) After completion of this form please follow directions for correct payment below.
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Email *
Child LAST name *
Child FIRST name *
Child Date of Birth (MM/DD/YY) *
MM
/
DD
/
YYYY
Child Entering Grade *
Required
My child has allergies and/or food restrictions *
My child will be attending camp: *
Required
Child T-shirt size  *
Parent #1 Name: Last, First (Ex. Smith, John) *
Parent #1 Address *
Parent #1 Phone Number (xxx-xxx-xxxx) *
Parent #1 Email *
Parent #2 Name: Last, First (Ex. Smith, John) *
Parent #2 Address *
Parent #2 Phone Number (xxx-xxx-xxxx) *
Parent #2 Email *
EMERGENCY CONTACT / ALTERNATE PICKUP RELEASE Name: Last, First (Ex. Smith, John) *
EMERGENCY CONTACT / ALTERNATE PICKUP RELEASE Phone Number (xxx-xxx-xxxx) *
EMERGENCY CONTACT / ALTERNATE PICKUP RELEASE  Relationship to child *
• I give permission to call an ambulance / have my child taken to the hospital in case of an emergency • I give permission to have my child's name and photograph used for promotional purposes, in reference to  the Camp Program  • I will not send my child to camp if they are exhibiting symptoms of illness. • St. Nicholas Greek Orthodox Shrine Church will not be held accountable in the case of accidental injury,  illness or death of camp participants. I understand that my child WILL BE REMOVED FROM THE CAMP at the discretion of the camp directors should they be disrespectful, disruptive to any counselor or camper,  and/or uncooperative and/or causes damage on any property during the duration of camp. *
Parent E- signature *
By typing your full name below you consent to the above information agreeing to the rules set by the Panagia's Garden camp directors and that all the above information is current and accurate.
Payment Instructions:

After submitting the above form, please follow the link to proceed to payment. Payment must be paid in full prior to the start of camp. 

A copy of your responses will be emailed to the address you provided.
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