PCPS Elementary Summer Camp - Registration Form
Please complete registration form and return $100 ($40 registration fee and $60 deposit) to the front office no later than May 3. Space is limited. Early Registration is open through April 8th - $40 registration fee is waived with Early Registration!
Student Information
Student Name (#1)
Your answer
2019-20 Grade Level
Student Name (#2)
Your answer
2019-20 Grade Level
Student Name (#3)
Your answer
2019-20 Grade Level
If more than 3 children attending, please list names and grade levels below.
Your answer
Parent Information
Home Address
Your answer
Father/Guardian Name
Your answer
Father/Guardian Phone Number
Your answer
Father/Guardian E-Mail
Your answer
Mother/Guardian Name
Your answer
Mother/Guardian Phone Number
Your answer
Mother/Guardian E-Mail
Your answer
Emergency Contacts and Authorized Pick-Ups
Name (#1)
Your answer
Phone Number
Your answer
Name (#2)
Your answer
Phone Number
Your answer
Name (#3)
Your answer
Phone Number
Your answer
Name (#3)
Your answer
Phone Number
Your answer
Not authorized to pick up:
Your answer
Select your sessions
Please select which weeks your child will attend, as well as any additional needs. Changes can be made with before/after care up to one week before the session begins. Before care hours are 7:30-8:00am, After care hours are 3:00-4:00 pm, regular full day hours are 8:00am-3:00pm.
Session 1
June 3-7
June 10-14
June 17-21
Session 2
June 24-28
July 8-12
Session 3
July 15-19
July 22-26
Finalizing Registration
We will be contacting you to request additional information, such as medical forms and payment information.
What is the best way to reach you?
How did you hear about PC?
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