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2021 Eagles Summer Camp Registration Form
Groups will be limited and will follow proper CDC guidelines for social distancing
Deadline for Payment May 20th, 2021
No more spots available for Students age 3-8
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* Indicates required question
Email
*
Your email
Student 1 Name
*
Your answer
Student 1 Date of Birth
*
MM
/
DD
/
YYYY
Student 1 Age (No more spots for age 3,4,7 &8)
*
9-10
Student 2 Name (If Applicable)
Your answer
Student 2 Date of Birth (If Applicable)
MM
/
DD
/
YYYY
Student 2 Age (If Applicable)
9-10
Clear selection
Student 3 Name (If Applicable)
Your answer
Student 3 Date of Birth (If Applicable)
MM
/
DD
/
YYYY
Student 3 Age (If Applicable)
9-10
Clear selection
Student 4 Name (If Applicable)
Your answer
Student 4 Date of Birth (If Applicable)
MM
/
DD
/
YYYY
Student 4 Age (If Applicable)
9-10
Clear selection
Home Address
*
Your answer
Mother's Name
*
Your answer
Mother's Cell #
*
Your answer
Father's Name
*
Your answer
Father's Cell #
*
Your answer
Mother's Email address
*
Your answer
Father's Email address
*
Your answer
Would you be okay if we served your child(ren) pizza?
Yes
No
Clear selection
Do you want extended care for your child(ren)? Additional $8/hour(per child)
Yes
No
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Any allergies (List students name with any allergies)
*
Your answer
Authorized People to pickup(other then parents listed above)
*
Your answer
Submitters Name (Signature)
*
Your answer
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