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 7-11)Pioneer Fun on the Farm (June 14-18)Both

    Full Day or Half Day?:* Full Day ($230 per each camp)Half Day ($130 per each camp)

    Parent or Guardian First Name:*

    Parent or Guardian Last Name:*

    Home Phone*:

    Cell Phone*:



    Emergency Contact Name*

    Emergency Contact Phone*

    Relationship to Camper*

    Camper Name: First & Last*

    Camper Age (Must be between ages 5-10 on June 1st)*

    Camper Birth Date (m/d/year) *



    Medical Conditions*

    Authorized Pick-up List*


    Once we receive your registration, the office send you a confirmation letter during business hours.