2026 Summer Camp Registration

Please fill out the form below to register your child for summer camp. You will be asked for payment details as well. Please pay the $40 deposit so we can enroll your child in camp, otherwise their space may not be guaranteed. Thank you.

Summer Camp Registration Form 2026

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

Parent Name*

First Last

Email*

Second Parent Name*

First Last

Email*

Please select the camp you are registering for:*

Opal Whiteley Nature Fairies Camp Makeup- Monday

Opal Whiteley Nature Fairies Camp Makeup- Tuesday

Child's Home Address*

Street Address Address Line 2 City State ZIP Code

Phone: Day time best number*

Phone: Day time best number second parent

Phone: Evenings/Alternate

Child's Name*

First Last

Age:*

Second Child's Name

First Last

Second Child's Age:

Please explain any custody issues we should be aware of:

Emergency Contact Person Name:*

First Last

Their Phone:*

Relationship to Child:*

Any Extra Information about Emergency Contact Person:

School your child(ren) attend(s), or mark Home schooled:*

Dietary Restricions for your child(ren):

Allergies, either known or suspected:*

Medications child(ren) will be taking:*

If this information changes, please notify us before camp begins. We should oversee or administer all medications.

Any physical ailments or restrictions on activities we should be aware of:*

Please let us know anything else we should know for your child to be sucessful in our camps:*

Pronouns for your child? Any special fears we should know?

Persons Authorized to pick up your child other than parents listed on this form, and their cell phone numbers:*

Sign this form by typing your name below:*

Payment

Daily rate per child

Price:

How many are you purchasing?

Please enter a number from 0 to 5.

Coupon Code or Referred By:

Donation to our Scholarship Fund for low-income families (optional)

Total

Payment Method

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

2026 Summer Camp Registration

Summer Camp Registration Form 2026

Payment

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