Camp Registration

Note: When submitting this form you will be prompted to pay the camp fee of $450. Please be ready with payment information. If you will use ESA you can use the code: GIRLS26 at check out.

Camper Information

Camper's First name

Camper's Last name

Preferred Name/Nickname:

Camper Age:

Camper Grade:

School (optional)

Parent/Guardian's Information

Parent/Guardian's Full Name

Relationship to Camper

Phone

Emergency Contact (Other than Parent/Guardian)

Emergency Contact

Emergency Contact Relation to student

Phone

Authorized Pick-Up (If applicable)

Name

Phone

Name

Phone

Medical and Health Information

Are there any allergies we should know of?

Are there any medical conditions or diagnoses we should be aware of?

Medications Taken During Camp Hours:

Are there any dietary needs/restrictions/requests?

Are there any special accommodations?

Social-Emotional and Learning Support

Anything you would like the staff to know about your child

Photo and Media Permission

Please check one:

I give permission for my child to be photographed/recorded for camp-related use (website, social media, marketing).

I do NOT give permission for my child to be photographed/recorded.

Participation and Liability Acknowledgement

I understand that participation in camp activities involves some level of physical activity and I agree to release and hold harmless the camp organizers and staff from liability except in cases of gross negligence.

Parent/Guardian Initials

I understand that the camp is a supportive, respectful, and inclusive environment. I agree that my child will follow camp expectations regarding kindness, safety, and participation.

Parent/Guardian Initials

Payment and Cancellation Policy

50% refund if cancellation is made by March 1, 2026

No refunds for cancellations after March 1, 2026.

No refunds will be issued for missed days due to illness, scheduling conflicts, or early withdrawal once camp has begun.

In the event the camp must be cancelled by the organizer, families will receive a full refund.

I certify that the information provided above is accurate and complete.

Signature

Printed Name:

Date

Month

Day

Year

Signature

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Tuition

Payment – Step Up for Students (Important)

If you plan to use Step Up for Students for payment use the code GIRLS26:

• Funds must be reserved within 3 calendar days of registration

• Your child’s seat will be held for 3 days pending fund reservation

• If funds are not reserved within this timeframe, the seat may be released

If you have questions about the Step Up process, please contact us promptly.

Amount

$450