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2018 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: $110 per week (activities and field experience included)
District Employees $90 per week
$10 Sibling Discount Available
Summer Camp Dates:  June 11th - August 3rd (closed during the week of July 4th)
Rising 4th-8th graders (students will be grouped by age)

Summer Camp  Program Directors:
Kirsten Baker and Crystal Munson
Phone:  803.691.6850

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