Kids Camp Registration

Warning!

This form cannot be submitted until an administrator completes the setup process to receive online payments.

Child Information

Child Name

t-shirt size:

Grade Child will be going into for the 2021-2022 year:

Emergency Contact Information

Emergency Contact Name

Emergency Contact Phone

Relation to Child:

Parent Information

Parent Name

Parent Email

This address will receive a confirmation email

Parent Phone

Address

Does your child have any medical concern/allergies we need to know about:

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Please fill out this form and click submit.