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2023 Summer Municipal Camp Registration Form
Must fill out a form for each camp for each child. Do not use one form for multiple camps. Contact us at
717-738-1167 x106 or
maria@ephratarec.com
with questions.
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* Indicates required question
Email
*
Your email
Camp Name (Exactly As It Appears in Flyer)
*
Your answer
Level (Swimming Lessons Only)
Level 1
Level 2
Level 3
Level 4
Level 5
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Camp Dates
Your answer
Camp Time
Your answer
Participant Name
Your answer
Participant Date of Birth
MM
/
DD
/
YYYY
Current Grade
Your answer
Parents' Names (Father and Mother)
Your answer
Parent Cell
Your answer
Parent Email Address
*
Your answer
Street Address
Your answer
Municipality **Participants who do not reside in a participating municipality must pay the class price listed with each program.
Your answer
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