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SRK Summer Camp Registration Form

 
Fill out this on-line form to register your child for SRK Summer Camp. After filling in all the information, you will then be given an opportunity to either continue your order on-line and pay via PayPal/Credit card, or to mail in your payment using a personal check or money order.
 

*Parent #1 Info:

*P1 Name:

*P1 Home Phone: 

*P1 Cell Phone: 

Parent #2 Info:

P2 Name: 

P2 Home Phone: 

P2 Cell Phone: 

*Home Address:

*Address:

*City:  *State:   *Zip: 

*email Address:
(we will email you confirmation papers)

*Child #1:

 

*Name:

*Age at Camp:

*Date of Birth: 

*Grade: 

Health/Allergy concerns?

Other Concerns? 

* How many weeks per child would you like to enroll?
(minimum 2 weeks per child): 
Please check the weeks below that you want this child to attend.

   Week 1 – May 29 to June 1

   Week 2 – June 4 to 8

   Week 3 – June 11 to 15

   Week 4 – June 18 to 22

   Week 5 – June 25 to 29

   Week 6 – July 2 to 6

   Week 7 – July 9 to 13

   Week 8 – July 16 to 20

   Week 9 – July 23 to 27

   Week 10 – July 30 to Aug 3

Child #2:

 

 Name:

Age at Camp:

Date of Birth: 

Grade: 

Health/Allergy concerns?

Other Concerns? 

How many weeks per child would you like to enroll?
(minimum 2 weeks per child):    
Please check the weeks below that you want this child to attend.

   Week 1 – May 29 to June 1

   Week 2 – June 4 to 8

   Week 3 – June 11 to 15

   Week 4 – June 18 to 22

   Week 5 – June 25 to 29

   Week 6 – July 2 to 6

   Week 7 – July 9 to 13

   Week 8 – July 16 to 20

   Week 9 – July 23 to 27

   Week 10 – July 30 to Aug 3

Child #3:

 

Name:

Age at Camp:

Date of Birth: 

Grade: 

Health/Allergy concerns?

Other Concerns? 

How many weeks per child would you like to enroll?
(minimum 2 weeks per child):   
Please check the weeks below that you want this child to attend.

   Week 1 – May 29 to June 1

   Week 2 – June 4 to 8

   Week 3 – June 11 to 15

   Week 4 – June 18 to 22

   Week 5 – June 25 to 29

   Week 6 – July 2 to 6

   Week 7 – July 9 to 13

   Week 8 – July 16 to 20

   Week 9 – July 23 to 27

   Week 10 – July 30 to Aug 3

*Who may pick up the children?

Check programs you are interested in:

Sports Camps   Extended Care   Hot Lunches   SRK After-School Program

Referral Info:

Friends that go to SRK or that referred you?  

Are you a resident of Heritage Harbor?                   Yes           No
Heritage Harbor residents get $10.00 discount per week on Summer Camp Rates

*Payment Method:

   I will mail in my paperwork along with a Check or Money Order

   I will process my Payment on-line from this website using PayPal, Credit or Debit Card. I understand there is a 3.5% processing fee to pay using this method.

Parent’s Authorization:

This health history is correct so far as I know, and the person herein described has permission to engage in all prescribed camp activities, and I understand that I must provide the signed consent & medical waivers on my Childs first day of camp.   Note:  You will be directed to the forms at the end of your enrollment selection.

I understand that if I enroll via PayPal on-line and use a debit or credit card, that I am being charged a 3.5 % processing fee.

 
 
 
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