Stateline Kids Club / Summer Camp Registration

Registration Type (Choose One)

 Summer Camp Fall / Spring Kids Club

Parent's Information

*Last Name
*First Name
*Address
*City
*State
*Zip
*Personal #
*Work #
*Your Email
*Emergency Contact
*Emergency #

Student Information:


*Child Name

*Age

*Grade

*School

*Date of Birth

Medical Information:

*Family Physician
*Physician's #
Allergies
Special Concerns
Parents! In order for your child to get the most out of this experience, it's important that parents get involved! This includes attendance in three programs, and volunteering 2 nights.
I would like to volunteer to:
 Help with Recreation Help with Music Help in the Kitchen or with Clean-up Serve as a Table Parent Bake Desserts

Please note the following fees:

Summer Camp

Cost per person $45

Stateline Kids Club

One (1) Student is $80 (for Fall & Spring)
Two (2) Students in the same family is $150
Three or more (3+) Students in the same family is $175