Circus Cascadia Summer Camp Registration Form 2021
Please fill out this form to begin the registration process.
Camp Hours are 10am till 3pm
Before and After care will be available at $15 per session
Before care starting at 8.30 am - 10 am Camp start
After care available till 5.30pm
Payment options: Please pay a deposit or full amount to hold your child's spot in the camp.
Please do this right when you finish sending this form to assist easy admin.
Pay using Paypal button on website.
Checks may be sent to:
Circus Cascadia, 8563 SE 257th Ave, Gresham, OR, 97080
A non-refundable deposit of $50 is required to reserve a spot in camp.
All other payments can be completed on first day of camp
You can also email
info@circuscascadia.org
to arrange payment.
* Required
Email address
*
Your email
Under the Big Top
Student Name
*
Your answer
Age and Grade level
*
Your answer
What camp are you signing up for?
*
June 14th-June 18th Under The Big Top $300
June 21st-June 25th Under The Big Top $300
June 28th - July 2nd Circus Mask Camp $325
July 12th - 16th. Under The Big Top $300
July 19th - 23rd Under The Big Top $300
July 26th - 30th Circus Mask Camp $325
August 9th - 13th Under The Big Top $300
August 16th - 20th Under The Big Top $300
August 23rd - 27th Circus Mask Camp $325
Required
Parent or Guardian #1
*
Your answer
Contact Number for Parent/Guardian
*
Your answer
Email address
*
Your answer
Parent or Guardian #2
*
Your answer
Contact Number for Parent/Guardian 2
*
Your answer
Email address for Parent/Guardian 2
*
Your answer
We care about the safety of all our campers. This camp is open to children whose guardians have been fully vaccinated against COVID-19. Check the box below to confirm that all eligible adults in your household are vaccinated or will be scheduled prior to the start of camp. We reserve the rights of admission. Please contact us if you have any questions.
*
I have read and agreed to this statement
Required
Will you be requiring before or aftercare?
*
Your answer
I give my permission for photographs and/or other forms of media to be used for program documentation without compensation to my child or myself. I understand no names will be used in these publications. *
*
Yes
No
Required
Consent for emergency care: I hereby grant permission to Circus Cascadia teachers to perform emergency care, including first aid and CPR on my child and transport my child as deemed necessary for further medical treatment in the event I am unable to be contacted. I further consent to medical or surgical treatment by any licensed physician and or hospital and the administration of surgeries and any other medical treatments deemed necessary or advisable in the event I am unable to be contacted.Electronically signed:
*
Your answer
How did you hear about us?
Your answer
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