To register your children for our fun and safe Summer Camp Program, please fill out and submit the following form.

Names of Children to be Registered

First Child's Name

Please enter the child's name.

First Child's Age

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Second Child's Name

Please enter the child's name.

Second Child's Age

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Third Child's Name

Please enter the child's name.

Third Child's Age

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Fourth Child's Name

Please enter the child's name.

Fourth Child's Age

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Parental Contact Information

Parent's Name

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Street Address (Must Be Physical Address)

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City

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Zip Code

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Mobile Phone

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Home Phone

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Email Address

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Parental Notes

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Emergency Contact Information

Emergency Contact Name

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Emergency Contact Telephone

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Emergency Contact: Additional Notes

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Additional Person Authorized for Pickup

Name

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TX DL Number

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Phone Number

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