Little Star Day Camp 2021 Registration
Please complete the following registration form. Our business office will be in touch with you regarding payment. If you have more than one child attending camp, you will need to fill out an additional form for each child. The first email address field below is the location where you will receive a copy of your registration responses. If you do not see the receipt of you responses in your inbox, please check your spam or promotions folder.
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Email *
Camper First Name: *
Camper Last Name: *
Parent 1 First Name: *
Parent 1 Last Name: *
Preferred Phone Number: *
Preferred Email Address (if different from the one listed above):
Home Address: *
Parent 2 First Name:
Parent 2 Last Name:
Preferred Phone Number:
Preferred Email Address:
Home Address (If different than primary address):
Emergency Contact Name and Phone Number: *
Relationship to Camper: *
Emergency Contact 2 Name and Phone Number:
Relationship to Camper:
Camper Date of Birth: *
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Grade/Class entering in August 2021: *
School Attending in August 2021: *
Camp pricing per week:
Weeks 2-9:
3 Day Camper - Half-Days 7:30 AM to 1:00 PM (PS 1/2 ONLY): $135
3 Day Camper - Full-Days  7:30 AM to 4:30 PM (PS 1/2 ONLY):  $185
5  Day Camper - Half-Days 7:30 AM to 1:00 PM: $165
5 Day Camper - Full-Days 7:30 AM to 4:30 PM: $250


*Week 1 is a 4-day Camp week and will be prorated.
**Week 10 is a 3-day Camp week and will be prorated.
Please select which week(s) your camper will be attending Little Star Day Camp. Half-Day hours will be 7:30 AM - 1:00 PM and Full-Days will be 7:30 AM - 4:30 PM:
3 Half-Days (PS 1/2 ONLY)
3 Full-Days (PS 1/2 ONLY)
5 Half-Days
5 Full-Days
Week 1: June 1- June 4
Week 2: June 7 - June 11
Week 3: June 14- June 18
Week 4: June 21 - June 25
Week 5: June 28 - July 2
Week 6: July 5 - July 9
Week 7: July 12 - July 16
Week 8: July 19 - July 23
Week 9: July 26 - July 30
Week 10: August 2 - August 4
For the purposes of invoicing, do you prefer to pay weekly or in full? *
I understand that Little Star Day Camp is relying on my child's registration to ensure proper staffing and safety protocols. Therefore, I understand and agree that if I cancel my child's registration within two (2) weeks of the registered week or weeks, I will be charged $50 per child per week registered. I will provide a credit card or make prompt payment to Little Star Day Camp for such fees; provided that I may cancel without penalty if the child is required to quarantine per current COVID-19 guidance and such quarantine will extend through one or more days of the registered week.
Please sign full name below to acknowledge you've read and agree to the above statement: *
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