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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Email *
Camp Name (Exactly As It Appears in Flyer) *
Level (Swimming Lessons Only) 
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Camp Dates
Camp Time
Participant Name
Participant Date of Birth
Current Grade
Parents' Names (Father and Mother)
Parent Cell
Parent Email Address *
Street Address
Municipality **Participants who do not reside in a participating municipality  must pay the class price listed with each program.  
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