Summer Day Camp Registration

Your Email*

Child's Full Name*

Grade child is entering next school year (2022-2023)*

Will your child be attending the 4-day or 5-day camp?*

Parent #1 Name*

(This is the first parent we will contact in case of an emergency)

Parent #1 Phone Number*

Parent #1 Alternate Phone Number

Parent #1 Email*

Emergency Contact/Parent #2 Name*

Emergency Contact/Parent #2 Phone Number*

Emergency Contact/Parent #2 Alternate Phone Number

Emergency Contact/Parent #2 Email*

Parent willing to chaperone a field trip? (If applicable)*

Primary Address of Child*

Street Address Address Line 2 City State ZIP Code

Secondary Address of Child

Street Address Address Line 2 City State ZIP Code

Child's Date of Birth*

Years Playing Organized Hockey*

Medical conditions or allergies? (If yes, please explain)*

Anything we need to know academically, socially, or emotionally about your child? (If yes, please explain)*

Any days/weeks you know the child will not be attending camp?*

*Note: Due to staffing and facility costs, we will not be able to pro-rate tuition fees

Special requests to be paired in class with a friend or family member (Requests are not guaranteed)