WINTER CAMP 2025
Please fill out this form and click submit.
Child 1 Information / Primer Niño(a)
Full Name / Nombre Completo
*
Grade / Grado
*
Please select one option.
3rd
4th
5th
Select Option
3rd
4th
5th
Gender / Genero
*
Please select one option.
Boy / Niño
Girl / Niña
Select Option
Boy / Niño
Girl / Niña
Food Allergies / Alergias
*
Please select one option.
Yes / Si
No
Select Option
Yes / Si
No
If YES, Please Explain:
Physical Limitations / Limitaciones físicas
*
Please select one option.
Yes / Si
No
Select Option
Yes / Si
No
If YES, Please Explain:
Child 2 Information (optional) / Segundo Niño(a)
Full Name / Nombre Completo
Grade / Grado
Please select one option.
3rd
4th
5th
Select Option
3rd
4th
5th
Gender / Genero
Please select one option.
Boy
Girl
Select Option
Boy
Girl
Food Allergies / Alergias
Please select one option.
Yes
No
Select Option
Yes
No
If YES, Please Explain:
Physical Limitations
Please select one option.
Yes
No
Option
Select Option
Yes
No
Option
If YES, Please Explain:
Parent Information / Padres
Full Name / Nombre Completo
*
Email / Correo Electronico
*
This address will receive a confirmation email
Phone / Telefono
*
Address / Direccion
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Emergency Contact / Contacto de Emergencia
Full Name / Nombre Completo
*
Phone / Telefono
*
Child/Niño(a) $235
Adult/Adulto $159
Payment / Pago
Credit/Debit Card Number
Expiration Date/CVC
Name on Card
Card Billing Address
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Submit
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