2023 Summer Camp Registration
Please note - If you are registering a child who is currently enrolled in Country Classroom or attended a previous year's summer camp, you do not have to repeat information that you have previously given us. Please submit this form with at least your child’s name and review and fill in any information that needs to be updated. You will still need to submit a signed permission form and up to date immunization records.
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Child's Information
Which session(s) are you registering for? *
Obligatoria
Child's Name *
Child's Preferred Name
Date of Birth
DD
/
MM
/
AAAA
Date of Adoption
DD
/
MM
/
AAAA
Is there a legal custody order that applies to this child?
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If the answer to the above was yes, please give any necessary details.
If you have already filled out this registration for a sibling and would like us to copy the address, parents' information, and emergency contacts from the sibling's registration, please enter their name here. Please look through carefully and fill in anything that would not be the same as the sibling, such as medical information, however.
Address
If the child lives with the primary guardian(s) full time, just fill out the address below.  If child lives with multiple guardians to an equal extent, skip this section and fill out addresses under the guardian section below.  If they live primarily with one guardian but spend time in another household as well, fill out the primary address in this section and include the secondary household address in the appropriate place in the guardian section.
Street Address
City
State
Zip Code
School District of Residence
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Mailing Address (if different from above)
Mailing City
Mailing State
Mailing Zip Code
Parent/Guardian Information
**Only fill in addresses if different from above.**
First Parent/Guardian
Relationship to Child
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First Name
Last Name
Only fill out this address if different from the child's main address of residence above.
Street Address
City
State
Zip Code
Home Phone
Cell Phone
Work Phone
Employer
Occupation
Email Address
Second Parent/Guardian
Relationship to Child
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First Name
Last Name
Only fill out this address if different from the child's main address of residence above.
Street Address
City
State
Zip Code
Home Phone
Cell Phone
Work Phone
Employer
Occupation
Email Address
Student lives with (check all that apply)
Person Responsible for Payment
How did you hear about our summer camp?
Siguiente
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