Register

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Register Online

When you Complete Your Registration Information on this page,
Click SUBMIT FORM and it will be sent to us.

You will then be taken to a page where you can pay with your Credit Card via PayPal
OR Mail a Check.

Your Registration will be CONFIRMED when we have received
BOTH your registration information and your choice of payment.
Thank You again and See You This Summer

*Please Note: Digital Media (computer lab) will not be offered this year.

You can also print the registration form by clicking here and please also print the waiver form by clicking here

Camper Name
Street Address
City and State
Zip Code
Home Telephone Number
Cell Phone Number
Email Address
Current Age (Male or Female)
Health/Mental Problems/Pertinent Information (Including Allergic Reactions, Food Allergies and Medications Being Taken)
I certify that all immunization and boosters are up to date on my child
Parent/Guardian Initials
Approx. Date of Last Tetnaus Booster
Camper Can Participate in Ice Cream Party - Yes No
  Pizza Party - Yes No
  Daily Snack/Drink - Yes No
Camper Transportation *Bike *Walk Car
*By checking walk off you are giving permission for your child to bike or walk to/from camp
Mother's (Legal Guardian) Name
Pertaining to the Mother - Are You
Single
Married
Divorced
Employed at
Work Phone
Home Phone
Cell Phone
Email
Address
City
State
Zip
 
Pertaining to the Father- Are You
Single
Married
Divorced
Employed at
Work Phone
Home Phone
Cell Phone
Email
Address
City
State
Zip
 
In case of illness/accident, list a relative/neighbor we may call if you can not be reached
Name
Phone
Children's Doctor
Phone
 
List below name(s) of person(s) you authorize to remove your children from camp. If you want someone else not listed to remove your children from camp, you must notify the camp staff in person or by written note signed by you (exclude primary and secondary contacts from above)
Name Name
Name Name
Campus Location Boca Raton at DKJA (Donna Klein) Sessions 1-4 Morikami Park Elementary available sessions 1-2
Which Session(s) are you registering for? Check ALL that apply.
T-Shirt Size
Indicate any OPTIONS (check all that apply) Extended Camp Hours (8:30-5:00 - $65.00 per week)
Additional T-Shirt(s) ($10 each)
Lunch $40.00 per week at Morikami Park Elementary (OPTIONAL)
Lunch $40.00 per week at Donna Kline (REQURED)
Any Special Requests or Situations? ie. names of fellow campers you wish to be grouped with?
I have read the waiver form. Please sign your name in the box. Click here to view the waiver
Once you click the submit button, you will be taken to the payment page.