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 to arrange payment.
Email address *
Under the Big Top
Student Name *
Age and Grade level *
What camp are you signing up for? *
Parent or Guardian #1 *
Contact Number for Parent/Guardian *
Email address *
Parent or Guardian #2 *
Contact Number for Parent/Guardian 2 *
Email address for Parent/Guardian 2 *
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. *
Will you be requiring before or aftercare? *
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. * *
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: *
How did you hear about us?
Never submit passwords through Google Forms.
This form was created inside of Paul BATTRAM. Report Abuse