Blackacre Summer Camp Registration 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*: Email* Address* 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) * Allergies* Medicines* Medical Conditions* Authorized Pick-up List* Signature* Once we receive your registration, the office send you a confirmation letter during business hours.