2023 Summer Day Camp Registration Please enable JavaScript in your browser to complete this form.Participant Name *FirstLastAge *Please note that children must have completed kindergarten or be similarly aged to attend camp.Date of Birth *More than one child in our family will be participating:YesNoParticipant Name 2FirstLastAgeDate of BirthParticipant Name 3FirstLastAgeDate of BirthName of Parent/Guardian *FirstLastWhat is your relationship to the participant?Is this your first time registering for Funhouse programs?YesNoCell Phone *Home PhoneEmail *Physical Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeOn-Island Emergency Contact *FirstLastEmergency Contact Phone *Please check the boxes beside each camp week you would like to attend. Week 1: June 26th -June 30thWeek 2: July 10th - July 14thWeek 3: July 17th -July 21stWeek 4: July 24th - July 28thWeek 5: July 31st- August 4thWeek 6: August 14th- August 18thWeek 7: August 21st- August 25thPlease list the first and last names of anyone who has permission to pick up your child from The Funhouse:If there is anyone who is specifically NOT ALLOWED to pick up your child, please list their names here:This information is kept confidential.Does your child have any allergies?Is there anything else you would like us to know?By signing this form, I declare that I am the legal parent/guardian of the minor child listed above and authorized to grant such permission. I agree to hold harmless The Funhouse, its employees, volunteers, or anyone connected with the Funhouse organization for any injury or other problems arising from participation in this program. *I agreeBy signing this form, I understand and agree that photographs/videos may be taken of The Funhouse Commons activities and may be used by The Funhouse Commons for promoting programs, classes, events, in print, TV, social media or on the website. *I agreeI do not agreeCompleting this form puts your child on the camp waitlist, and does not automatically enroll your child in the program. A Funhouse staff member will contact you within 5 business days to confirm availability for the weeks you would like to register.Signature *Clear SignatureWebsiteSubmit
