First Camper's Name *

First Name

Last Name

Siblings' Name

First Name

Last Name

Siblings' Name

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Family or friends who may pick up your child *

Please write their full name

First Name

Last Name

Family or friends who may pick up your child

Please write their full name

First Name

Last Name

Family or friends who may pick up your child

Please write their full name

First Name

Last Name

Acknowledgement of Terms *

I acknowledge that my payment secures spot(s) for my child(ren) and is non-refundable after June 17.

I acknowledge that a completed Consent for Emergency Medical Treatment (LIC627) for the child(ren) listed above must be filed with Monica Ros before the start of camp.

I acknowledge that a completed Emergency Contact Form (LIC700) for the child(ren) listed above must be filed with Monica Ros before the start of camp.