Name_______________________________________________________________________________________________

Home Phone___________________________     Bus/Cell Phone________________________________________________

Address (if different from above)___________________________________________________________________________

Relationship to child?_________________________________________________________ Date:______________________

Signature of person
responsible for account (required)_________________________________________________________________________

Camp Hours are from 7AM-6PM. A late pick-up fee of $3.00 per minute will be charged for each child remaining after 6PM. Your camp fees are due on the first day of attendance each week. Accounts must be kept current.
You MUST list below two names of responsible family members of friends who, in case of an emergency, can be contacted and have the authority to pick up your child.