Summer Specialty Camp Signup
Summer Specialty Camp Signup
Child's Full Name  * 
Child's Age:  * 
Grade last completed:  * 
Parent/Legal Guardian Full Name  * 
Address  * 
Parent/Guardian Home Phone
Parent/Guardian Daytime phone  * 
Emergency Contact during event: (name, address, relationship and phone) * 
Other Information we need to know:
Please select the camp you would like to sign up for. Please Note: If you need before or after camp, please exit and sign up through our child development center, 540-825-9798.  * 
Your Email Address  * 
Total $
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