SUMMER CAMP 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 17th

June 24th

July 1st

July 8th

July 15th

July 22nd

July 29th

August 5th

August 12th

August 19th

Signature:

Date:

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