Last:

First:

Birthdate:

Street:

City:

State: Zip:

Home Phone:

Gender: Boy / Girl

Grade 2025-26: N (Preschool or not yet Kindergarten) K (Kindergarten) 1 2 3 4 5 6 7 8 9 10 11

School 2025-26:

Grade 2026-27: N (Preschool or not yet Kindergarten) K (Kindergarten) 1 2 3 4 5 6 7 8 9 10 11

School 2026-27:

Special Placement Requests: One Camper/Friend:

Grade Level (if different from above):

Toilet Trained? (Preschool Only) Yes / No

Does your child have an IEP or 504 Plan? Yes / No If so, we would appreciate a copy be provided to camp.

Allergies, Medications, or Medical Concerns:

Will your child require an Epipen at camp? Yes / No

Does your child receive any services during the school year (Speech, OT, PT, etc.), If so, please specify:

Choose your program!

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Camp runs for 8 weeks from Monday June 29th to Friday August 21st, 2026
Week 1 will run Monday to Thursday and is a 4 day week.

Choose Which Weeks You Want - Check Each Week Requested

A minimum of 3 weeks is required.

Week 1: Mon Jun 29 - Thu July 2

Week 2: Mon Jul 6 - Fri Jul 10

Week 3: Mon Jul 13 - Fri Jul 17

Week 4: Mon Jul 20 - Fri Jul 24

Week 5: Mon Jul 27 - Fri Jul 31

Week 6: Mon Aug 3 - Fri Aug 7

Week 7: Mon Aug 10 - Fri Aug 14

Week 8: Mon Aug 17 - Fri Aug 21

Choose Your Add Ons!

If taking the bus, please see where transportation is available here.

AM Extended Hours (from 7:45am) $50/Week

PM Extended Hours (to 5:30pm) $50/Week (only available to PM campers)

Lunch Program $65/Week (Not available to AM campers)

AM Bus $110/Week

PM Bus $110/Week (Only available to Full Day campers)

Midday Bus (2 pm camp departure) $110/Week (Only available to Mini Day campers)

Mother or Guardian Contact Information:

Name:

Cell Phone:

Address (if different from camper):

Home Phone (if different from camper):

Business Phone:

Email Address:

Father or Guardian Contact Information:

Name:

Cell Phone:

Address (if different from camper):

Home Phone (if different from camper):

Business Phone:

Email Address:

Approve Release Form

I agree to all the conditions in the Release document below. (Click to enlarge)

Approve Enrollment Policies

I agree to all the conditions in the Enrollment Policies document below. (Click to enlarge)