ASRT Spring Break Camp 2019
Thank you for applying to Austin Scottish Rite Theater Spring Break Camps!
We are happy to provide a great week long experience for your child!
Please complete the following camp registration form and read through the material below before submitting.

Date of Camp: March 18 - March 22, 2019
Camp Fee: $275 / per week
Camp Hours: 9:00 a.m. - 4:00 p.m.
Drop-off starts at 8:45. Pickup ends at 4:15.

Email address *
Spring Break Camp 2019 offers only ONE session, but please make sure your child fits the age parameters before checking off the session and completing registration! *
Required
Preferred Method of Payment *
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Camper General Information
Camper's Full Name *
Your answer
Camper's Age/Gender *
Your answer
Address, City, State, Zip *
Your answer
Parent/Guardian's Full Name *
Your answer
Parent/Guardian's Phone Number *
Your answer
Parent/Guardian's Email Address *
Your answer
Parent/Guardian's Address (if different than child's)
Your answer
Alternate Parent/Guardian's Name
Your answer
Alternate Parent/Guardian's Email/Phone Number
Your answer
Who is allowed to pick up your child? *
Your answer
Health Statement
**any prescriptions or over-the-counter medications must be left with our camp office staff in original packaging.
Primary Care Physician (name/number/address) *
Your answer
Drug Allergies *
Your answer
Environmental Allergies *
Your answer
Food Allergies/Dietary Restrictions *
Your answer
Any other health concerns?
Your answer
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