Please fill out the form as completely as possible     *required fields
Child's First Name:*

1st Parents First Name:*   

2nd Parents First Name:

Child's Age:*

Home Phone #:*

 Child's Last Name:*

1st Parents Last Name:*   

2nd Parents Last Name:

Email Address:*

Alternate Phone #:





Confirm Email Address:*

Emergency #:*
Choose your Camp Date(s):*   
June 23th - July 3rd
July 7th - July 17th
July 21th - July 31st
Aug 4th - Aug 14th
 T-Shirt Size:*
Child
Small
Medium
Large
Extra Large
 Adult
Small
Medium
Large

Grade your child is entering:*

Names of any persons who
might also pick up your child:

Names of friends you want to group with:

Swimming Ability:*
Little or no experience
Some swimming experience
Strong swimmer

We want to post pictures of the fun your child is having!
Can we use his or her picture?: Yes No

Medical Insurance Name:*

Policy Holders Name:*

Does you child have any medical issues we should know about:
Home Address:*
Please tell us something
about your child: