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SUMMER CAMP REGISTRATION
CHILD’S INFORMATION
Name
*
First
Sex
*
School
*
Week Options
*
Week 1: June 24-28 Field Trips Paddle Boarding, Movie/Bowling, Kayaking La Jolla Caves, Sky Zone, Tubing/Wakeboarding
Week 2: July 8-12 Field Trips Movie/Roller Skating, Wild River Water Park, Fishing at Lake Dixon, Sky Zone, Tubing/Wakeboarding
Week 3: July 22-26 Field Trips Whale Watching, Movie/Mini Golf, Wild Rivers Water Park, Sky Zone, Tubing/Wakeboarding
Day Camp
Teen Sleep Away Camp in Los Angeles June 10-14
Dates for Day Camp
Pick Up/Drop Off Service $50/child for Week
*
Yes
No
Drop Off/Pick Up Location
*
Alga Norte Park 8:15am/3:30pm
Encinitas Park 9am/3pm
Address
*
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Address
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Afghanistan
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Birthday
Age
*
Water Safe
*
Yes
No
Parents Info
Parents Name
*
Mom's Cell Phone Number
*
Dad's Cell Phone Number
*
Divorced
*
Yes
No
Custody
Joint
Mom
Dad
None
Emergency Contact
*
Relationship
*
Phone Number
*
Medical Information
Tetanus Shot Current?
*
Yes
No
Wear Glasses or Contacts
*
Yes
No
Asthma
*
Yes
No
Allergies
*
Medications
*
Behavioral/Health Problems:
*
Health Insurance Company:
*
Policy #
*
Group #
*
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*
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*
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