Dance Adventure Summer Camp Registration

This special program is only open to campers who have already been approved by Jennie Miller.

Note1: The "Lives with" field refers to who the camper lives with, i.e. father, mother, parents, grandparents, etc.

Note2: Only fill this application out if you've checked in with Jennie Miller.

Note 3: Pricing is slightly higher if you are paying by credit card. If you would like to pay by check, make sure you choose Pay by check pricing when you register.

'Camper' Information

Camper First name*
Camper Middle name
Camper Last name*
Lives with
School
Birthdate
1. Month
2. Day
3. Year
Grade
Gender
Primary Phone

Address Line 1*
Address Line 2
City*
Country*
State*
State*
Zip Code*

Add New Camper

'Parent 1' Information Copy contact information from 'Camper'

Custodial parent

Parent Email*

Email address must be unique

Parent First name*

Parent Last name*

Gender

Primary Phone*

Work Phone

Other Phone

Occupation

Address Line 1*

Address Line 2

City*

Country*

State*

Zip Code*

'Parent 2' Information Copy contact information from 'Camper'

Custodial parent

Parent Email

Email address must be unique

Parent First name

Parent Last name

Gender

Primary Phone

Work Phone

Other Phone

Occupation

Address Line 1

Address Line 2

City

Country

State

Zip Code

'Emergency Contact 1' Information

Emergency Contact First name

Emergency Contact Last name

Gender

Primary Phone

Work Phone

Other Phone

Relation to Camper

I accept Camp Kinderland's Terms of Service

I accept Bunk1's

By clicking the submit button, you are certifying that the above information is accurate to the best of your knowledge.

Submit

Dance Adventure Summer Camp Registration

'Camper' Information

Choose Session(s)

'Parent 1' Information Copy contact information from 'Camper'

'Parent 2' Information Copy contact information from 'Camper'

'Emergency Contact 1' Information

Thanks for your submission.