Your Camper’s Adventure Starts Here Enroll Today. Adventure Awaits. Guardian Last Name* Guardian First Name* Street Address* City/Town* State* Zip Code* Contact Phone 1* Contact Phone 2 Number of Campers* Camper 1 (required) Child Last Name* Child First Name* Person ID Number* Date of Birth* Month* —Please choose an option—JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day* —Please choose an option—12345678910111213141516171819202122232425262728293031 Year* —Please choose an option—202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995 Sex* MaleFemale Camper 2 Child Last Name Child First Name Person ID Number Date of Birth Month —Please choose an option—JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day —Please choose an option—12345678910111213141516171819202122232425262728293031 Year —Please choose an option—202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995 Sex MaleFemale Camper 3 Child Last Name Child First Name Person ID Number Date of Birth Month —Please choose an option—JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day —Please choose an option—12345678910111213141516171819202122232425262728293031 Year —Please choose an option—202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995 Sex MaleFemale Camper 4 Child Last Name Child First Name Person ID Number Date of Birth Month —Please choose an option—JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day —Please choose an option—12345678910111213141516171819202122232425262728293031 Year —Please choose an option—202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995 Sex MaleFemale Camper 5 Child Last Name Child First Name Person ID Number Date of Birth Month —Please choose an option—JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day —Please choose an option—12345678910111213141516171819202122232425262728293031 Year —Please choose an option—202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995 Sex MaleFemale Camper 6 Child Last Name Child First Name Person ID Number Date of Birth Month —Please choose an option—JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day —Please choose an option—12345678910111213141516171819202122232425262728293031 Year —Please choose an option—202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995 Sex MaleFemale Please Select the Weeks of Attendance You may select multiple weeks and we are closed on July 3 June 29 - July 3July 6 - July 10July 13 - July 17July 20 - July 24July 27 - July 31August 3 - August 7August 10 - August 14August 17 - August 21 Case Name* Case ID Number* DCPP Office Location* Case Worker Email* Case Worker* Contact Phone* Agency Please Note All weeks of attendance must be consecutive with a two week minimum. Additionally this enrollment form must be completed entirely Enrollment Includes All transportation, 1 camp t-shirt, tote bag, trophies, awards, certificates and insurance. Enrollment Agreement Its understood an agreed by and between the agency and the director that since the enrollment of each camp is limited and the director incurs numerous expenses and obligations as the result of the registration of the above named child(ren), all fees must be paid in full by conclusion of the campers stay at camp and that no refunds will be made. No child will be admitted to camp without a signed and completed health form. The foregoing represents the entire agreement between the parties and cannot be modified except upon the express written consent of the director. This agreement may be terminated by Agency upon written notice to the director within (3) business days of this agreement. By Checking this Box you Agree to the Terms and Conditions of This Application.
