2019 Camp Collegium Registration Form
Please pay close attention to the following registration dates and payment deadlines:

Camp Registration: There is a $60.00 non-refundable registration fee that holds your camper's spot. This registration fee MUST be received within 14 days after submitting a completed registration form. Failure to submit your registration fee within 14 days forfeits your camper's spot in the program. Exceptions will not be considered.

Final Camp Balance: Final balances (weekly camp tuition, extended day fees - if applicable) are due by Friday, May 24, 2019. Exceptions will not be considered.

Early Bird Special: If payment in full is received by Friday, March 22, 2019 please deduct 5% from your weekly camp tuition, excluding extended day fees and the non-refundable registration fee.

Sibling Discount: 10% camp tuition discount on additional campers from the same family, excluding extended day fees and non-refundable registration fees. Please complete one (1) registration form per camper.

Space is limited and we suggest registering as early as possible. Please complete one registration form per camper.

Questions? Contact Child Care Director, Ms. LaNae Horsey: LHorsey@ccs.us or (610) 903-1300 ext. 6328.

Camper First Name *
Your answer
Camper Last Name *
Your answer
Age on June 24, 2019 *
2019-2020 Grade Level *
Remember, 2019-2020 is next school year.
I Am Registering My Child As A *
Campers are entering K-6th grade in August 2019. Counselors-In-Training are entering 7th-10th grade in August 2019.
I Am Registering My Child As A
The Counselor-In-Training program has reached capacity and is accepting registration for WAITING LIST ONLY. Counselors-In-Training (C.I.T.s) are entering 7th-10th grade in August 2019
Camper Street Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Camper T-Shirt Size *
Registered campers receive one (1) free camp shirt. Please indicate size below.
Primary Parent/Guardian Name *
Your answer
Secondary Parent/Guardian Name
Your answer
Primary Email Address *
Your answer
Primary Phone Number *
(XXX-XXX-XXXX)
Your answer
Indicate Primary Phone Type *
For the primary phone number you indicated, please select type from the list below.
Emergency Contact #1 *
Below, please indicate the first and last name of an individual (other than the primary and secondary parent/guardian) authorized to be an emergency contact. This individual will be contacted in the event of an emergency in which a parent/guardian is unavailable.
Your answer
Emergency Contact #1 Relationship To Camper *
Below, please indicate the relationship between the emergency contact listed above and your camper.
Emergency Contact #1 Primary Phone *
Below, please write the primary phone number for the individual you indicated above. (XXX-XXX-XXXX)
Your answer
Emergency Contact #2 *
Below, please indicate the first and last name of an individual (other than the primary and secondary parent/guardian) authorized to be an emergency contact. This individual will be contacted in the event of an emergency in which a parent/guardian is unavailable.
Your answer
Emergency Contact #2 Relationship To Camper *
Below, please indicate the relationship between the emergency contact listed above and your camper.
Emergency Contact #2 Primary Phone *
Below, please write the primary phone number for the individual you indicated above. (XXX-XXX-XXXX)
Your answer
Emergency Contact #3
Below, please indicate the first and last name of an individual (other than the primary and secondary parent/guardian) authorized to be an emergency contact. This individual will be contacted in the event of an emergency in which a parent/guardian is unavailable.
Your answer
Emergency Contact #3 Relationship To Camper
Below, please indicate the relationship between the emergency contact listed above and your camper.
Emergency Contact #3 Primary Phone
Below, please write the primary phone number for the individual you indicated above. (XXX-XXX-XXXX)
Your answer
Authorized Pick Up Contact #1 *
Below, please indicate the first and last name of an individual (other than the primary and secondary parent/guardian) you pre-authorize to pick up your camper. This individual will be required to show photo identification when picking up your camper. Additionally, you are required to make the Camp Director aware, prior to pick-up time, that the individual will pick up your camper.
Your answer
Authorized Pick Up Contact #1 Primary Phone *
Below, please write the primary phone number for the individual you indicated above. (XXX-XXX-XXXX)
Your answer
Authorized Pick Up Contact #2 *
Below, please indicate the first and last name of an individual (other than the primary and secondary parent/guardian) you pre-authorize to pick up your camper. This individual will be required to show photo identification when picking up your camper. Additionally, you are required to make the Camp Director aware, prior to pick-up time, that the individual will pick up your camper.
Your answer
Authorized Pick Up Contact #2 Primary Phone *
Below, please write the primary phone number for the individual you indicated above. (XXX-XXX-XXXX)
Your answer
Authorized Pick Up Contact #3
Below, please indicate the first and last name of an individual (other than the primary and secondary parent/guardian) you pre-authorize to pick up your camper. This individual will be required to show photo identification when picking up your camper. Additionally, you are required to make the Camp Director aware, prior to pick-up time, that the individual will pick up your camper.
Your answer
Authorized Pick Up Contact #3 Primary Phone
Below, please write the primary phone number for the individual you indicated above. (XXX-XXX-XXXX)
Your answer
Non-Authorized Pick Up Contact #1
Below, please indicate the first and last name of any individual that is NOT permitted to pick up your camper under any circumstances. Please also list their relationship to the camper.
Your answer
Camp Collegium Photo Release *
From time to time, photos of campers "in action" will be taken to be used on our website, on our social media accounts, and by outside publications. This is a great way to recognize the efforts of our campers and to inform the surrounding community about the exciting things happening at Camp Collegium. Please answer "YES" if you will allow us to use your child(ren)'s photos for the above purposes or answer "NO" if you do not want us to use your child(ren)'s photos for the above purposes.
Weekly Camp Registration (7:30am-4:30pm) *
.Please select the weeks below in which you are registering your child. Please select all that apply.
Required
CIT WAITING LIST - Weekly Camp Registration (7:30am-4:30pm)
The weeks below have received full capacity for the CIT Program and are accepting registration for WAITING LIST ONLY. To be placed on the waiting list for the weeks below at the tuition rates, please check all that apply. Families placed on the waiting list will be notified by Friday, May 31, 2019 is spaces become available.
Weekly Extended Day Registration (4:30pm-6:00pm)
Please select the weeks below in which you are registering your child. Please select all that apply.
Please total your weekly tuition, applicable extended day fees, and include a $60.00 non-refundable registration fee. Below, please indicate your payment method. *
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