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*