Registration Options

Full Payment ($335.00)

Funds paid toward Summer Camp are not tax deductible and are non-refundable (even those used for vouchers for other students.)

Who's Comin' to Summer Camp?

Student Name

Email for confirmation

Confirm Email for confirmation

Student Phone Number

Student Address

Gender

Male
Female

Grade

Date of Birth

Name 2 students going to camp (we will try to room you with at least one.)

Important Stuff We Gotta Ask

Medical Insurance Company

Policy Holder Name

Group #

Plan or Policy #

Medical Insurance Company Phone Number

Family Physician Name

Family Physician Phone Number

List Any Applicable Physical Limitations (Asthma, diabetes, allergies, etc,), and/or special instructions:

List Any Food Allergies OrRestrictions:

List ALL medication you plan to bring to SCAMP 2019 and what they are for

*Students can possess and take their own medication. If you do not feel comfortable with your teen taking their own medication you must submit in writing that you would like assistance for your teen with their medication.

Emergency Contact Name

Relationship to student

Mobile

Secondary Contact

Relationship to student

Mobile

Legal Stuff The Lawyer Makes Us Do

Terms

I have read and agree to the terms above.

Like to scholarship a student? (Not tax deductible.)

Amount$

Recipient Email

We will send an email with the voucher code. It will expire on May 24th, 2019.

Add Voucher

Do you have a Coupon Code?

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