Summer Camp Registration 2018To register, please fill out the form below and click submit. Parents *Please enter one or both parents first and last names:Address *Please provide full mailing address:Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountryAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweEmail *Please provide an email contact address.Phone Please enter contact number with area codePick Up Please provide names of people who will be picking up your child.Church Leave blank if you do not regularly attend a church.Early Drop-Off / Late Pick-Up Please check the appropriate box below if you will require an early drop-off or a late pick-up. Childcare will be available one hour before (8 am) and one hour following (5 pm) for $2.50 per hour per child.Early drop-offLate pick-up Registration Information for Child OneName1 Name of first childDate of Birth1 mm/dd/yyAge1 Age of childGrade1 Grade child will have completed in JuneMedicare Number1 Please add child's medicare number for use in case of emergency.Info1 Please list any allergies, medical concerns or anything else we should know about your child.Preferences For most camps children will have their own choice of activities. However, for attendance and lunch the children are divided into groups. If your child would prefer to be in a group with a friend or sibling please note their name in the space above.Camps Attending1 Please check the camps this child will be attending.VBSMINICYOC1CYOC2 (Sorry Camp is Full)PreS VBS - July 9-13 (morning) MINI - July 9-13 (afternoon) CYOC1- Create-Your-Own Camp #1 - July 23-27 CYOC2 - Create-Your-Own Camp #2 - July 30-Aug 3 PreS - Preschool Camp (Ages 3-5) Aug 13-17 Registration Information for Child TwoName2 Name of Second ChildDate of Birth2 mm/dd/yyAge2 Age of ChildGrade2 Grade child will have completed in JuneMedicare Number2 Please add child's medicare number for use in case of emergency.Info2 Please list any allergies, medical concerns or anything else we should know about your child.Preferences For most camps children will have their own choice of activities. However, for attendance and lunch the children are divided into groups. If your child would prefer to be in a group with a friend or sibling please note their name in the space above.Camps Attending2 Please check the camps this child will be attending.VBSMINICYOC1CYOC2 (Full)PreS VBS - July 9-13 (morning) MINI - July 9-13 (afternoon) CYOC1- Create-Your-Own Camp #1 - July 23-27 CYOC2 - Create-Your-Own Camp #2 - July 30-Aug 3 PreS - Preschool Camp (Ages 3-5) Aug 13-17 Registration Information for Child ThreeName3 Name of Third ChildDate of Birth3 mm/dd/yyAge3 Age of ChildGrade3 Grade child will have completed in JuneMedicare Number3 Please add child's medicare number for use in case of emergency.Info3 Please list any allergies, medical concerns or anything else we should know about your child.Preferences For most camps children will have their own choice of activities. However, for attendance and lunch the children are divided into groups. If your child would prefer to be in a group with a friend or sibling please note their name in the space above.Camps Attending3 Please check the camps this child will be attending.VBSMINICYOC1CYOC2 (Full)PreS VBS - July 9-13 (morning) MINI - July 9-13 (afternoon) CYOC1- Create-Your-Own Camp #1 - July 23-27 CYOC2 - Create-Your-Own Camp #2 - July 30-Aug 3 PreS - Preschool Camp (Ages 3-5) Aug 13-17Instructions VerificationPlease enter any two digits *Example: 12This box is for spam protection - <strong>please leave it blank</strong>: