EmailMe Form - Passport to Fun Summer Camp 2013

Camper's Name *

First Last

Camper's Age

Gender

Birthday

Parent/Guardian Name(s)

Phone

### - ### - ####

Address

Street Address City State / Province / Region Postal / Zip Code Country / Region

Email *

Special Notes About Camper

Second Camper

If you would like to register a second camper please fill out the following section if they are to be registered for the same days as the first camper, if you would like them registered for different days please fill out a new form.

Second Camper's Name

First Last

Second Camper's Age

Second Camper's Gender

Second Camper's Birthday

Camp Days

Select Camp Days and Times

Week 1: "Now that's Italian"
(6/17 - 6/21)

Week 1:

Week 2: "Dinosaur Dig"
(6/24 - 6/28)

Week 1:

Week 3: Grand Canyon Camping (7/1 – 7/5, no camp on Thursday, 7/4)

Week 3:

Week 4: England's Fantasy and Fairytales (7/8 - 7/12)

Week 4:

Week 5: African Jungle Safari (7/15 - 7/19)

Week 5:

Week 6: Mexican Fiesta (7/22 - 7/26)

Week 6:

Week 7: Hawaiian Beach Party (7/29 - 8/2)

Week 7:

Week 8: Outta this World
(8/5 - 8/9)

Week 8:

Week 9:Dizzy's Big Top Circus (8/12 - 8/16)

Week 9:

Week 10: Wild West Showdown (8/19 - 8/23)

Week 10:

Week 11: Pirates and Mermaids/Caribbean
(8/26 - 8/30)

Week 11:

Payment Options

We require a 50% of the camp total and the remainder will be due on the first day of camp each week. This deposit is non-refundable, but it is transferable to other days or services.

Card Type

Name on Card

Card Number

Expiration Date

Billing Zip Code

Paypal

Yes, I'd rather use PayPal

Check here if you'd rather be billed through PayPal (will be sent through email)