Summer Camp Summer Camp Registration Summer Camp Parent/Guardian First Name * Parent/Guardian Last Name * Email Address * Phone Number * Camper(s) Name(s) * Week 1 June 3 – 7, 2024 Deposit Per Camper Per Week: $50.00 Quantity Week 2 June 10 – 14, 2024 Deposit Per Camper Per Week: $50.00 Quantity Week 3 June 24 – 28, 2024 Deposit Per Camper Per Week: $50.00 Quantity Week 4 July 8 – 12, 2024 Deposit Per Camper Per Week: $50.00 Quantity Total Deposit Credit / Debit Card Payment * Credit / Debit Card Payment Credit / Debit Card Payment Credit / Debit Card Payment Month 123456789101112 Credit / Debit Card Payment Year 20242025202620272028202920302031203220332034 Credit / Debit Card Payment Billing Address * Billing Address Street Address Street Address Street Address Cont. Street Address Cont. City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal If you are human, leave this field blank. REGISTER
