2023 Summer Youth Program Registration
Dates: June 12th - 16th
            June 19th - 23rd
            June 26th - 30th
Time: 9:00am - 3:00pm
Location: Lake City Community School
                  614 Silver St; Lake City, CO 81235
Contact: Silver Thread Public Health - 970-944-0321
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Email *
Child Name (Separate form to be completed for each child) *
Please select dates the child will attend camp *
Please select the grade the child will be in for the 2023 - 2024 school year *
Age of child *
Parent/Legal Guardian *
Local Address *
Phone (please indicate cell, work, home) *
OK to text?
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Local Emergency Contact *
Emergency Contact Phone *
Allergies and any Pertinent Medical Conditions
My child has permission to ride their bike or walk home at the end of the camp day *
**Camp will start at 9:00am sharp and end at 3:00pm sharp each day.**

**Please plan to drop your child off on their first day of camp in order to:
1) Sign paperwork
2) Make payment ($75/week)
3) Meet the camp staff!

**Please send the following items with your child each day:
1) Lunch
2) Water Bottle
3) Sunscreen
**We will provide snacks and lunch on Fridays**
I have read the above information about 1st day drop off and what my child needs to bring to camp each day *
A copy of your responses will be emailed to the address you provided.
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