Registration Form

Summer Camp Registration Form
Camper Name *
Camper Allergies *
Birth Date *

Month Day Year
Camper Sibling 1 Name *
Birth Date *

Month Day Year
Select Full Day Camp Dates

Week 1: August 3-7 FD Week 2: August 10-14 FD
Select Half Day Camp Dates

Week 1: August 3-7 HD Week 2: August 10-14 HD
Spanish Language Skill Level

Beginner Intermediate Fluent
First Time Camper? *

Yes No
Parent or Legal Guardian Information
Parent/Legal Guardian

First Name Last Name
Address *
City *
State *
Zip *
Parent Email
Cell Phone 1 *

Area Code Phone Number
Cell Phone 2

Area Code Phone Number
Home Phone *

Area Code Phone Number
Emergency Contact Info
Emergency Contact Name(if parent or guardian is not available) *
Emergency Number *

Area Code Phone Number
Emergency Number #2 *

Area Code Phone Number
Other Information
How did you hear about Spanish camp?
Health Information
Are immunications up to date?

Yes No
Any activity the camper should be restricted from?
Any physical, mental or other condition that would require special attention or medication while at camp?
List all medications, both prescribed and over the counter, all medications will be turned into the camp leader. Bring all medication in original containers.
List any allergies (ex: bees,peanuts, dairy)
Any dietary needs that we should know about?
Camper Photo Release
I agree that photos of my child can be taken on used on for camp social media purposes

Yes No
Payment Information

$25 Non-Refundable Registration Fee Due with Application
Method of payment

Credit Card Intuit Invoice (sent by email) PayPal
- Be certain to enter your email address correctly on the registration form to receive confirmation via email with in 5 days.
By hitting submit and putting your initials, you agree that you are the parent or legal guardian of the above named camper, and are over the age of 18. In case of medical emergency or general medical care, I give consent for medical treatment for the aboved named camper by authorized personnel. The camp carries secondary insurance. I understand that the above named camper will only be released to the names listed above, an update may be done at registration. I certify that my child has my permission to attend camp and participate in all activites.
Electronic signature, please initials *
Should be Empty:

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Summer Camp Registration Form

Parent or Legal Guardian Information

Emergency Contact Info

Other Information

Health Information

Camper Photo Release

Payment Information