2019 Summer Camp Registration Form
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 6/1/2019:(youngest to oldest) *
4. Camper's Grade(s) in August 2019: (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. Waterpark: If you are a resident of Ave Maria - do you have a membership at the Waterpark? (not necessary for enrollment) *
  • Yes
  • No
21. Swimming: Is your child swimming on their own?: *
  • Yes
  • No
22. If you wish, please tell us more about your child's swimming abilities:
23. Camp Fees are: $150 for a full week (40 hours) or $100 for a half week (20 hours)
  • Ok
24. Please Choose Your Weeks: *
  • Week 1: June 3 – 7
  • Week 2: June 10 – 14
  • Week 3: June 17 – 21
  • Week 4: June 24 – 28
  • Week 5: July 1 – 5
  • Week 6: July 8 – 12
  • Week 7: July 15 – 19
  • Week 8: July 22 – 26
  • Week 9: July 29 - Aug. 2
  • Week 10: Aug. 5 – 9
25. Are you enrolling your child(ren) for 1/2 day or full day? *
  • 1/2 Day
  • Full Day
26. If choosing 1/2 day camp - please indicate session:
  • Morning Session - 8am-12pm
  • Afternoon Session - 12pm-4pm
27. Which day(s) of the week is your camper coming? *
  • Monday-Friday
  • Monday
  • Tuesday
  • Wednesday
  • Thursday
  • Friday
28. If necessary, please use the box below to give more information about the days and dates you are enrolling for:
29. Payments are made in advance of the week ahead on your camper’s 1st day of attendance for that week. Please type your full name in the box below as an acknowledgement of this policy. *
30. 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/dates 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 on our 1st day of camp each week)
  • 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
31. Card Number:
32. Expiration date:
33. CVV Code: (3 or 4 digit # from the back of the card):
34. Billing Zip Code:
35. Auto Pay: If you are paying weekly and would like your weekly fees to be automatically processed using the card you have provided please indicate here:
  • Yes
  • No
36. When you click submit you will be automatically directed to THE WATER PARK LIABILITY WAIVER – please fill it out even if your child will not be attending camp on waterpark days. *
  • Ok