If you are human, leave this field blank.Camp fees are $300/week or $60/day (Early registration discount if paid by May 5th for Summer Camp $250/week or $50/day).ScheduleCheck if you want June 5-9, 2023 ($250 if paid by May 5th or $300 after) Check if you want June 12-16,, 2023 ($250 if paid by May 5th or $300 after) Check if you want June 19-23, 2023 ($250 if paid by May 5th or $300 after) Check if you want June 26-30, 2023 ($250 if paid by May 5th or $300 after) Check if you want July 10-14, 2023 ($250 if paid by May 5th or $300 after) Check if you want July 17-21, 2023 ($250 if paid by May 5th or $300 after) Check if you want July 24-28, 2023 ($250 if paid by May 5th or $300 after) Check if you want July 31-Aug 4, 2023 ($250 if paid by May 5th or $300 after) FOR SUMMER CAMP: If paid after May 5th, the weekly rate is $300 (daily rate $60). If paid by May 5th, the weekly rate will be $250 (daily rate $50).1st Child's First Name1st Child's Last Name1st Child's Age1st Child's Date of Birth1st Child's School1st Child's Grade for school year 2023/20241st Child's GenderMaleFemale2nd Child's First Name2nd Child's Last Name2nd Child's Age2nd Child's Date of Birth2nd Child's School2nd Child's Grade for school year 2023/20242nd Child's GenderMaleFemale3rd Child's First Name3rd Child's Last Name3rd Child's Age3rd Child's Date of Birth3rd Child's School3rd Child's Grade for school year 2023/20243rd Child's GenderMaleFemalePerson to Contact in Emergency: Parent/GuardianFirst Name/RelationshipLast NameParent/Guardian Home or Cell PhoneParent/Guardian Work PhoneAddressApt, suite, etc.CountryUnited States (US)United Kingdom (UK)CanadaAustralia---AfghanistanÅland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAmerican SamoaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelauBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraÇaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqRepublic of IrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Martin (Dutch part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSan MarinoSão Tomé and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaWestern SamoaYemenZambiaZimbabweCityStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces (AA)Armed Forces (AE)Armed Forces (AP)American SamoaGuamNorthern Mariana IslandsPuerto RicoUS Minor Outlying IslandsUS Virgin IslandsZip codeParent/guardian EmailPine Shores MemberYesNoOther ChurchSecond Contact/RelationshipName, home, work and cell phone numbers please.Third Contact/RelationshipName, home, work and cell phone numbers pleaseMedical HistoryPlease list any allergies, illnesses, current medications and diet restrictions and explain. If none, please answer \"none\"Does your child have any limitations that will require adaptations to the program or field trip?Please answer Yes or \"none\" (if yes, please explain.)Field Trip and General ReleaseYesNoMy child has my permission to attend all field trips included in the Day Camp under the supervision of Pine Shores Presbyterian Church. I read, understand and agree with the following conditions: - All campers will be participating in the field trips. If my child arrives late or leaves early, I will be responsible for taking him/her to and from the field trip site and making prior arrangements with the Camp Director. - Proper attire and sun protection will be needed and I will provided the aforementioned as necessary. - All campers shall follow the established program and guidelines. Public school policies of attire and safety apply. Any campers can and will be expelled from the program due to disciplinary misconduct, with no camp refund. - The parents and/or guardian, in consideration for Pine Shores Presbyterian Church providing facilities, instruction and supervision in the registered activity, does hereby: (a) assume all risk of possible damage or injury involved through participation of my child in the registered activity, (b) request permission to have my child participate in the activity with full knowledge that said activity could result in damage or injury to participant. - I give my permission for use of photography including my child in church publicity. - I understand that registration fees are non-refundable.Is there any other information you wish to share with us?Submit