C.A.P.S PROGRAM REGISTRATION

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Parent / Guardian First Name

Parent / Guardian Last Name

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Country

Phone

Email

Participant Name

DOB

T-Shirt Size

Campers Start Date:

Time of Arrival:

Campers Start Date:

Time of Departure:

Days:

Monday

Tuesday

Wednesday

Thursday

Friday

Medical Conditions/ Allergies:

Emergency Contact:

Please check which weeks your children will be attending KIDZERCISE Summer Camp:

June 19th

June 26th

July 3rd

July 10th

July 17th

July 24nd

July 31st

August 7th

August 14th

August 21st

Signature:

Date:

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