Summer Day Camp Registration

    Section I: Participant Information

    Last Name, First Name and Middle Initial (required)

    Please Select

    Your Birthdate (required)

    Please List Any Allergies:

    Home Phone

    Cell Phone

    Your Email (required)

    Address (required)

    City, State and Zip (required)

    Section II: Parent / Guardian Information

    First and Last Name (required)

    Please Select

    If you selected "Other" above, please tell us your relationship to the participant

    Home Phone

    Cell Phone

    Your Email (required)

    Address (required)

    City, State and Zip (required)

    Section III: Emergency Contact

    First and Last Name (required)

    Phone (required)

    Relationship To The Participant (required)