Camp Choice

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Camper Information

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Campers First Name
Campers Last Name
Campers Date of Birth
Camp Address
Camper City
Camper State
Camper Zip

Campers Medical Information

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Special Needs Inventory
  • No Special Needs
  • Allergies
  • Asthma/Breathing
  • Autism
  • Behaviour Challenge
  • Cognitive Disability
  • Developmental Delay
  • Diet
  • Fine/Gross Motor Skills Difficulty
  • Physical Disability
  • Requires 1:1
  • Social Difficulty
Camper Physician
Camper Physician Phone
Camper Dentist
Camper Dentist Phone
Camper Insurance Company
Campers Additional Comments

Event Information

Quantity
Price
Total
Camp Registration Deposit

Choose this option to make the initial deposit. The balance will be due 30 days prior to the camp.

X
$
300.00=
$
0

Day Camp 2

Use this to complete your Registration (Full payment is due 30 days prior to your camp start date)

X
$
590.00=
$
0

Day Camp Full Registration

Use this option to purchase the camp in full.

X
$
890.00=
$
0

Kay Foundation

Kay Foundation Scholarship

X
$
25.00=
$
0

Final Total:
$
0

Contact Information

Country*
State / Province*
Address*
City*
*
*
*
*
*
*
Email*
Confirm Email*
Phone*

Payment Information

Amount*
$
Name on Card*
Card Number*
Additional Comments

Security Code