SBW Summer Camp Enrollment

2018 SBW Summer Camp

Please note that all fields followed by an asterisk must be filled in.

First Name*

Last Name*

E-Mail Address*

Street Address*

City*

State/Prov*

Zip/Postal Code*

Cell Phone*

Student's Name*

Age*

School

Please list ADA Accommodations needed (allergies)

Please check the week(s) you wish to participate:*

July 30 - August 3 - COOKING/NUTRITION ($150)

Transportation To and From Camp*

Do you authorize OPMI to use photos of your child on our website and/or promotional material?

	YES
	NO

Approved Child Pick Up (Please list names, phone number and relation)*

Emergency Contact (Please list names, phone number and relation)*

Payment due the Friday before each week - how will you pay?

	Check
	Cash
	Online
	CC

OPMI Payment Policy*

I understand that any portion of the camp that my child cannot attend shall be forfeited without refund or credit. Payments are due before camp starts and any payment made on the first day of camp is subject to late fees.

Statement of Understanding*

By checking this box I accept and understand that there are 8 different weeks of Summer Camp. Camp runs from 9:00am-3:00pm. Any portion of the camp that my child cannot attend shall be forfeited without refund or credit. I also understand that I am responsible for picking up my child from camp on time. If I am more than 10 minutes late, I accept and understand that fees will be applied.