Summer Camp Application

I understand that camp will begin on Monday, June 22, 2026 and end on Friday, July 31, 2026: *

Date of youth admission? *

I Understand the last day of camp is Friday, July 31, 2026? *YesNo

I understand that the camp doors open at 7:30am) ? *

I understand the official start time for camp is 9am, and that youth may not arrive after the start time. *

I understand youth are to be picked up and off the premises of the program by 5:00 pm: *YesNo

I understand the camp will provide the opportunity for youth to participate in activities, trips, and academics: *

I understand the camp calendar will be given to all families on the first day of camp: *

I understand the cost of camp include 5 out of 6 trips, activities, breakfast, lunch, a camp shirt, & child care. *

I understand that my camper(s) will be provided camp shirt on their first day of camp? *

I understand breakfast & lunch will be provided or youth can bring their own? *YesNo

I understand youth must bring their own snack or may purchase snack from the program *

Does your camper have any allergies? *

I understand that youth must wear his/her sneakers daily? *

I understand to put camper’s name on all belongings sent to camp each day: *

I understand guardians/parents are responsible for spending money? *

I understand the program is not are responsible for electronic devices? *

I understand that all youth will participate in daily academic curriculum: *

What are your child strengths & weakness in regards to his/her academics:?

I understand the camp reserves the right to terminate services of any camper that demonstrates disruptive or unsafe behavior with no refund? *

I understand the camp calendar is subject to change due to weather, a trip will be reciprocated." *

I understand that a $50 deposit is required to guarantee your camper a slot in the program? *

Do you have "subsidy" or "private pay" method? *Subsidy/CopayPrivate Pay (Cash/Debit)

Which payment arrangement do you prefer: *

I understand there will be "NO REFUNDS" for any summer camp deposits/payments: *

I received complete written program information at the time enrollment? *YesNo

I agree to update the emergency contact/parental consent form whenever information changes occur or every 6 months? *YesNo

Person(s) designated by parent to whom child may be released? *

Youth Name *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Date Of Birth *

Grade *

Parent/ Legal Guardian Name *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Mobile Phone *

Email Address *

Place of Employment *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Phone *

Parent/ Legal Guardian Name

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Mobile Phone

Email Address

Place of Employment

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone

Text

Emergency Contact Name *

Street Address *

City

State/Province

ZIP / Postal Code

Phone *

MAY YOUR CHILD BE RELEASED TO THIS PERSON *YesNo

Emergency Contact Name *

Street Address *

City

State/Province

ZIP / Postal Code

Phone *

MAY YOUR CHILD BE RELEASED TO THIS PERSON *YesNo

Name Of Child’s Physician/Medical Provider *

Street Address *

City

State/Province

ZIP / Postal Code

Phone *

Special Disabilities (If Any) *

Allergies(Including Medication Reaction) *

Medical or Dietary Information *

Additional Information On Special Needs Of Youth:

Health Insurance Coverage or Medical Assistance: *

Policy Number *

Youth Can Be Transported *

Youth May Walk/Trips *

Youth May Go Wading? *

Youth May Go Swimming? *

How will your youth be dismissed from the program? *Picked UpWalk HomePicked Up/Walk Home