camper registration online 1142012

Camp Summertime

Online Camper Registration

Please complete all information this form. Camper is limited and will fill on a first come / first serve basis.

Returning families may enroll starting 12:01 a.m. January 15, 2012.

New families may enroll starting 12:01 a.m. February, 1, 2012.

Your confirmation for your child's enrollment will be emailed to you within one business day.

Camper first name

Camper last name

Gender

Girl Boy

Date of birth

Grade in September 2012

School

If possible group with:

List any medical or health concerns / conditions

Minimum Enrollment is 10 days

Session #1: June 18-June 22

Session #1 June 18-June 22

Days each week

Session #2: June 25-July 20

Session #2 June 25-July 20

Days each week

Session #3: July 23-Aug 27

Session #3: July 23-July 27

Days each week

Session #4: July 30-Aug 3

Days each week

Session #5: Aug 6-Aug 10

Days each week

Session #6: Aug 13-Aug 17

Days each week

List any special day/week requests:

Camp Overnight ($60)

Hot Lunch Preorder $5 per day(enter number of lunches requested)

T-Shirt size / order

child small child medium child large adult small adult medium adult large adult extra large

2nd Camper first name

2nd Camper last name

Gender

Girl Boy

Date of Birth

Grade in September 2012

School

List any medical or health concerns / conditions

If possible group with:

Minimum Enrollment is 10 days

Session #1: June 18-June 22

Days each week

Session #2: June 25-July 20

Days each week

Session #3: July 23-July 27

Days each week

Session #4: July 30-Aug 3

Days each week

Session #5: Aug 6-Aug 10

Days each week

Session #6: Aug 13-Aug 17

Days each week

List any special day/week requests:

Transportation Needed

Bus Pick-up Point

Extended care needed:(additional cost)

Camp Overnight ($60)

Friday, July 12, 2013 Friday, August 2, 2013

Hot Lunch Preorder $5 per day(enter number of lunches requested)

T-Shirt size / order

child small child medium child large adult small adult medium adult large adult extra large

Home Address

City

State

Zip Code

Home phone

Mother first name

Mother last name

Mother cell phone

Mother work phone

Mother email address

Father first name

Father last name

Father cell phone

Father work phone

Father email address

Emergency Contact name

Emergency Contact phone

Enter deposit amount to be charged: $200 per camper

payment method

Check # or Visa / Master Card #

Expiration Date

CCV code

Conditions of Enrollment

If paying by check send payment to:____ Camp Summertime______ P.O. Box 420 Agoura Hills, CA 91376