SUMMER 2021 CAMP AVE MARIA REGISTRATION
Questions marked by * are required.
1. Child(ren's) Name(s) (First, Last) (if multiple, list by age - youngest to oldest) *
2. Date(s) of Birth: (mm/dd/yy) (youngest to oldest) *
3. Camper's age(s) as of 6/1/2021:(youngest to oldest) *
4. Camper's Grade(s) in August 2021: (youngest to oldest) *
5. Street Address: *
6. City, State, Zip *
7. Guardian Name (First, Last): *
8. Guardian Relationship to Camper: *
9. Guardian Home Phone Number:
10. Guardian E-Mail Address: *
11. Guardian Cell Phone Number: *
12. Name(s) and cell phone number(s) of people other than guardian who may be bringing your child to and from camp:
13. Please tell us how you heard about our Summer Camp: *
14. Allergies: Please list any allergies your child may have:
15. Medications: Please list any medications your child may be taking and the reason for taking them:
16. Dietary Restrictions: Please list any dietary restrictions your child may have:
17. Conditions: Please list any chronic illness or medical conditions your child may have:
18. Injuries: Please list any injuries or operations your child has or had:
19. Special Needs: In order for our staff to ensure your child has a happy experience at summer camp, please share any special needs your child may have - e.g., learning disabilities, limitations, dislikes, fears etc...
20. Camp Fees are: $100/week or $25/day.
  • Ok
21. Please indicate your weeks below. Partial weeks are an option - choose your weeks 1st and then your days (in #22): *
  • Week 1: June 14 – 18
  • Week 2: June 21 – 25
  • Week 3: June 28 – July 2
  • Week 4: July 5 – 9
  • Week 5: July 12 – 16
  • Week 6: July 19 – 23
  • Week 7: July 26 – 30
  • Week 8: August 2 – 6
22. Which day(s) of the week is your camper coming? *
  • Monday-Friday (5 days) ($100)
  • Monday ($25)
  • Tuesday ($25)
  • Wednesday ($25)
  • Thursday ($25)
  • Friday ($25)
23. If necessary, please use the box below to give more information about the days and dates you are enrolling for:
24. Payments are made in advance of the week ahead on your camper’s 1st day of attendance for that week. Please type your initials in the box below as an acknowledgement of this policy. *
25. First Payment: In order to hold your child's place in camp the 1st week’s camp fee must be paid at the time of registration. Please select one of the payment options below. *
  • I am including my credit/debit card information, please charge my card in advance for all of the days/weeks I have indicated
  • I am including my credit/debit card information, please charge my card for the 1st week of camp (after that we will pay in person on the Monday of each week we attend)
  • I will come in or phone in payment (a place is not held until payment is made)
  • I will pay my camp fees using the PayPal link on the 'Camp Fees' page
26. Card Number:
27. Expiration date:
28. CVV Code: (3 or 4 digit # from the back of the card):
29. Billing Zip Code:
30. When you click submit you will be automatically directed to The LIABILITY WAIVERS. *
  • Ok