Participant Name (1) *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Are you registering more than one camper? *

Yes

No

Are you registering an additional camper? *

Yes

No

Weeks Requested: Please select all the weeks you'd like your child(ren) to come to camp. *

Week 1: June 30th - July 5th (closed July 4th)

Week 2: July 7th - 11th

Week 3: July 14th - 18th

Week 4: July 21st - 25th

Week 5: August 4th - 8th

Week 6: August 11th - 15th

Week 7: August 18th - 22nd

Week 8: August 25th - 29th

Parent/Guardian Name *

First Name

Last Name

Physical Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell Phone *

(###)

###

####

Parent/Guardian Name

First Name

Last Name

Cell Phone

(###)

###

####

Payment Tier *

$250 per week

$200 per week

Scholarship

Would you like to gift another camper with one week of summer camp?

This additional amount will be added to your first invoice.

Yes

GALA HELP: Are you interested in helping at us at the Funhouse Gala this summer? *

All helpers will receive one (1) free week of summer camp in exchange for their time/work at the gala.

Yes

No

Emergency Contact *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

I understand and agree that photographs/videos taken of my child(ren) at the Funhouse Commons may be used by the Funhouse Commons for promoting our programs, classes, events, in print, TV, social media or on the website. *

I Agree

I Do Not Agree

By signing this form, I declare that I am the legal parent/guardian of the minor child(ren) listed above and am authorized to grant such permission. I agree to hold harmless the Funhouse Commons, its employees, volunteers, or anyone connected with the Funhouse Commons organization for any injury or other problems arising from participation in this program. *

I Agree