2021 Summer Camp @SRYC

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For Ages 5-10

Camper Name

*

Parent/Guardian Name 1

*

Parent/Guardian Name 2

*

Email

*

This address will receive a confirmation email

Phone

*

Address

*

Emergency Contact Name

*

Emergency Contact #

*

Week 1: 6/28 - 7/2

N/A (0) Full Day ($225)

Amount

Week 2: 7/6 - 7/9

N/A (0) Full Week ($225)

Amount

Week 3: 7/12 - 7/16

N/A (0) Full Week ($225)

Amount

Week 4: 7/19 - 7/23

N/A (0) Full Week ($225)

Amount

Week 5: 7/26 - 7/30

N/A (0) Full Week ($225)

Amount

Week 6: 8/2 - 8/6

N/A (0) Full Week ($225)

Amount

Week 7: 8/9 - 8/13

N/A (0) Full Week ($225)

Amount

Week 8: 8/16 - 8/20

N/A (0) Full Week ($225)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

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