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Summer Vacation Camp
June 22nd - 26th, July 13th - 17th, August 10th - 14th, August 24th - 28th 
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Last Name *
First Name *
Parent 1 *
Parent 1 Phone Number *
Parent 1 Email *
Parent 2
Parent 2 Phone Number
Parent 2 Email
Birthdate *
MM
/
DD
/
YYYY
Health Concerns/Allergies *
Shirt Size *
June Summer Session
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July Summer Session
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 August Summer Session
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 August Summer Session
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Payment - $550/camper/session ($500 for additional campers or sessions) *
Do we have your permission to charge the deposit ($100/camper/session) to the credit card we have on file?
Would you prefer to pay the remainder: *
Would you prefer to pay the remainder: *
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