Blackacre Summer Camp Registration

 

Summer Camp Registration Form

Register now for our camp(s) and pay later! A request for payment will be sent two weeks prior to camp.

    Summer Camp Date:* Exploration (June 22-26)Fun on the Farm (July 6-10)Both

    Full Day or Half Day?:* Full Day ($225 per each camp)Half Day ($125 per each camp)

    Parent or Guardian First Name:*

    Parent or Guardian Last Name:*

    Home Phone*:

    Cell Phone*:

    Email*

    Address*




    Emergency Contact Name*

    Emergency Contact Phone*

    Relationship to Camper*


    Camper Name: First & Last*

    Camper Birth Date*

    Camp Assignment


    Allergies*

    Medicines*

    Medical Conditions*

    Authorized Pick-up List*


    Signature*

    After clicking submit button, you will receive a confirmation e-mail.