Child's Name *

First Name

Last Name

Birthdate *

Please put the year of your daughter's birth, not the current year.

MM

DD

YYYY

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent Name *

First Name

Last Name

Parent Phone Number *

(###)

###

####

Emergency Contact Name *

PLEASE DO NOT LIST THE SAME PARENT INFORMATION SUBMITTED ABOVE. This is meant to be an additional emergency contact in the event that the listed parent cannot be reached.

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Select which dates you will attend. Check one or both boxes. *

Girls can attend one or both weeks of camp. Each week has a separate curriculum with different activities and themes.

July 8-12

July 15-19