Payformix Online Forms - Demo Form: Summer Camp Registration

Summer Camp Registration

CAMPER INFORMATION

Child's first name Child's last name Date of birth Age at camp start Gender

T-shirt size

Please tell us how you heard about the Summer Camp:

Friend

Website

Brochure

Other

PARENT/GUARDIAN CONTACT INFORMATION

First name Last name Street address City State Zip Preferred phone # Work phone # Home phone #

EMERGENCY CONTACT INFORMATION

Emergency contact first name Emergency contact last name Relation Emergency phone #

ENROLLMENT SELECTION

July 11 - 15

July 18 - 22

July 25 - 29

August 1 - 5

Are you a Faculty/Staff member?

Do you require after camp care from 4-5:30 p.m. this week? Do you wish to purchase lunch for your child for this week?

Are you registering another child for the same session? Instructions for this question: If you are registering multiple children, when registering your first child select NO for this question. For each additional child select YES for this question:

Yes

ACKNOWLEDGEMENT OF TERMS

Summer Camp is a fee-for-service program based on confirmation enrollments and secured deposits. In order to reserve your child's spot in the Summer Camp, full payment must be received for each child and session you are registering for. If the session(s) you are trying to register for has filled, your child will be placed on the wait list in the order that the registrations are received.

The standard state health form is required by May 31st and must be signed by your children's physician.

Parent or Guardian - Your signature below indicates compliance with summer camp regulations.

Parent/Guardian Signature Date

PAYMENT

$350.00 registration fee is required to reserve your child's spot in the Summer Camp. Pay online using your credit card (VISA or MasterCard).

First name Last name Card number Expiration Cvv Billing address City State Zip