Summer Camp Sign Up Form

Camp Name:

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Age Group:

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Parent / Guardian Name:(*)

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Email:(*)

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Address:(*)

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City:(*)

Please enter the City.

State:(*)

Please enter the State.

Zip Code:(*)

Please enter the Zip Code.

Home Phone:

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Cell Phone:

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Child Name:(*)

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Birthdate:(*)

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Child Name:

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Birthdate:

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Child Name:

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Birthdate:

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Photographic Permission (used for only Kids Cottage advertising):(*)

Yes

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Any Known Allergies:(*)

Yes

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If yes, please describe:

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Payment Options:(*)

Charge my saved credit card the $50 non-refundable, one time Registration Fee

I will call now to pay the Registration Fee to hold my spot

Please choose a payment option

You are required to pay a $50 registration fee at this time. Please call us at 302-644-7690 with payment information. The weekly camp fee is due on the Monday prior to your child's camp. Please also bring all forms that will be emailed to you on Monday of camp week. Thanks!

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Summer Camp Sign Up Form

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