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Registration Form

Camp session
Camper information
First name:
Last name:
Date of birth:
Age:
Gender:
Adress:
City:
Zip:
Parent/Guardian Information
Full name:
Relationship to camper:
Phone Number:
Email Address:
Emergency Contact Name:
Emergency Contact Phone:
Medical Information
Allergies:
Medications:
Any medical conditions or special needs we should be aware of:
Insurance Information
Health Insurance Provider:
Policy Number:
Primary Care Physician:
Physician’s Phone Number:
Permissions and Releases
I give permission for my child to participate in all camp activities.
I authorize the camp staff to seek medical attention for my child in case of emergency.
I give permission for photos/videos of my child to be used in camp promotional materials.
I have read and agree to the camp’s terms and conditions.
Camp Fee
- Total Fee: $ 350 per week
- Registration Fee (applied to total camp fee) $ 150
Extended Day Service 35$ per am/ 35$ per pm or 60$ per day
Payment Method: 
Payment Information: 
Additional Questions
Does your child have any previous experience with YouTube or video creation?
If yes, please describe:
What type of YouTube channel is your child interested in creating?

We will respond by email and provide payment option for registration. 

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