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Millpond March Break Camp Registration 2026
We are excited to have you joining us for March Break camp! Please fill out the following form and send the deposit to reserve your spot.
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Email
*
Your email
Parent First Name
*
Your answer
Parent Last Name
*
Your answer
Phone Number
*
Your answer
Name of Child Attending
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Your answer
Home Address
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Your answer
Child's Birth Date
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MM
/
DD
/
YYYY
Additional Care Required
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Before Care starting at 8:00am for an additional $25 per week
After Care until 5:00pm for an additional $25 per week
No additional care required
Other:
Required
Name of Emergency Contact #1
*
Your answer
Emergency Contact #1 Relationship to the child
*
Your answer
Phone Number of Emergency Contact #1
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Your answer
Emergency Contact #2
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Your answer
Emergency Contact #2 Relationship to the Child
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Your answer
Phone Number of Emergency Contact #2
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Your answer
Please list any of the following: Current medications, Medication allergies, Food allergies, Chronic health concerns, diagnoses or any prevalent medical information. Write NA if there is nothing to note.
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Your answer
Please inform us of any other information you think we may need to know. Thank you.
Your answer
How did you hear about Camp at Millpond?
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Your answer
A copy of your responses will be emailed to the address you provided.
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