Camp Spark Registration Application Form
Event Dates: Saturday, June 22 - Saturday, June 29
Event Address: Gita Nagari Eco Farm, 534 Gita Nagari Rd, Port Royal, PA 17082
Contact us at (872) 267-0935

LIMITED SPOTS AVAILABLE!

10% sibling discount available. 

Register by June 1st to receive the early bird discounted rate of $600 per camper. Registration fee on/after June 2nd will be $650. Registration closes after June 7th.
 
Registration is incomplete without payment.
Accepted forms of payment are - Zelle (iskcongitanagari@yahoo.com) or Check (in the name of Gita Nagari Eco Farm, mailed to Gita Nagari Eco Farm & Sanctuary, 534 Gita Nagari Road, Port Royal, PA 17082).
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Email *
Child's Name *
Child's Birth Date *
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Child's Gender *
Child #2's Name
Child #2's Birth Date
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Child's Gender
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Child #3's Name
Child #3's Birth Date
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Child's Gender
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Home Address (including street, city, and state) *
Parent's Name *
Other email addresses that you want to receive camp-related communication at.
Cell Phone Number *
Alternative Phone Number
List detailed information about any special needs or allergies your child(ren) have. Include information about medications and precautions.
Persons, besides parents, authorized to pick up your child on the last day of camp. List names and phone numbers.
Have you made your payment yet? *
What form of payment have/will you use?  PLEASE INCLUDE MEMO "KIDS SUMMER CAMP". *
PARENT AUTHORIZATION
I agree that the staff or the institution offering this service is not liable for any unexpected accidents. In the event I cannot be reached, I hereby give the staff permission to administer first aid and/or obtain emergency medical care for my child. Any expense incurred will be accepted by me. I give permission for my child to be picked up by authorized persons in case there is a need. I give permission for my child to be photographed and videographed on the campsite and understand that these may be used for publicity purposes.
Parent Authorization *
Type your name here to electronically sign the form. *
A copy of your responses will be emailed to the address you provided.
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