GUARDIAN INFORMATION

Full Name *

Phone Number *

Email *

CHILD(REN) INFORMATION

Number of Children

Please Select

0
1
2
3
4
5
6
No elements found. Consider changing the search query.
List is empty.

Full Name (Child 1)

Age (Child 1)

Medical Conditions / Allergies (Child 1)

Camp Enrollment

June 9-13th (8-4pm)

June 16-20th (8-4pm)

Additional Concerns (Child 1)

Full Name (Child 2)

Age (Child 2)

Medical Conditions / Allergies (Child 2)

Camp Enrollment (Child 2)

June 9-13th (8-4pm)

June 16-20th (8-4pm)

Additional Concerns (Child 2)

Full Name (Child 3)

Age (Child 3)

Medical Conditions / Allergies (Child 3)

Camp Enrollment (Child 3)

June 9-13th (8-4pm)

June 16-20th (8-4pm)

Additional Concerns (Child 3)

Full Name (Child 4)

Age (Child 4)

Medical Conditions / Allergies (Child 4)

Camp Enrollment (Child 4)

June 9-13th (8-4pm)

June 16-20th (8-4pm)

Additional Concerns (Child 4)

Full Name (Child 5)

Age (Child 5)

Medical Conditions / Allergies (Child 5)

Camp Enrollment (Child 5)

June 9-13th (8-4pm)

June 16-20th (8-4pm)

Additional Concerns (Child 5)

Full Name (Child 6)

Age (Child 6)

Medical Conditions / Allergies (Child 6)

Camp Enrollment (Child 6)

June 9-13th (8-4pm)

June 16-20th (8-4pm)

Additional Concerns (Child 6)

EMERGENCY CONTACT

Emergency Contact Name *

Emergency Contact Phone # *

AGREEMENT & CONSENT

Permission to Treat *

I authorize the camp staff to seek medical treatment for my child in case of an emergency.

Liability Waiver *

I agree to the LvL.5 Waiver of Liability and Release (see link below)

View and Sign the LvL.5 Waiver

(If you haven't done so already)

Photo Release

I give permission for my child(ren) to be photographed or recorded during camp for promotional use.

I do not give permission for my child(ren) to be photographed or recorded.

PAYMENT INFORMATION

Select Quantity for Each Week *

LvL.5 Camp Week 1 (Per Child)

$400

LvL.5 Camp Week 2 (Per Child)

$400

*100% secure & safe payments*

Signature *

Clear

Date *