Summer at HPCA
Camp Duration: July 5-August 20, 2021
Site Address: 6801 Sheriff Road Landover, MD 20785
Contact us at (301) 773-4079 or email:
Parent's Name *
Attendee's Name and Birth date *
Attendee's Mailing Address *
Attendee's Current School (if applicable) *
Email *
Best Contact Number *
Has the attendee participated in this summer program before? *
Does the attendee have updated shots/immunization records? (REQUIRED FOR ADMISSIONS) *
Which weeks will your child attend? Select all that applies (Weekly cost: $200) *
Dietary restrictions (food allergies or restrictions) *
Does the attendee have any medical conditions that may require medication administration? If yes, please provide details. *
Emergency Contact Information (List specific names and numbers of designated individuals for emergency contact as well as drop off/pick up) *
I understand that I will have to pay a non-refundable registration fee of $125 on or before June 11th. *
All payments for the summer program will be submitted through Givelify beginning April 16, 2021
Be sure to download the Givelify app through the App Store or Google Play; or visit
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