Camp Registration

Summer Camp Registration/Payments

	Introduction and Information:
	ONE REGISTRATION PER FAMILY, PLEASE * Each application and processing/reservation fee MUST be accompanied by a Health Form with physician’s signature, or application will not be processed. A copy of the most recent physical examination completed within the past two years and showing up-to-date immunizations is required. PLEASE NOTE: The Director reserves the right to withdraw any camper whose influence or actions are deemed harmful or who will not abide with rules and policies of the camp. In the event of dismissal or withdrawal, there will be no refunds. *ITEMS WITH AN ASTERISK () MUST BE FILLED OUT BEFORE SUBMITTING!!!**
	AGREEMENT: I, the parent/guardian, give permission, for my son/daughter to participate in EHT PAL’s Summer Camp. I assume all risks and hazards incidental to such participation, including transportation to and from activities I do hereby waive, release, absolve, and indemnify and agree to hold harmless the Egg Harbor Township Police Department, the Egg Harbor Township Police Athletic League, its organizers, sponsors, supervisors, participants, and persons transporting my child, and for any and all claims arising out of any injury to my child, whether the result of negligence or for any other cause. It is understood that signing this form indicates I have read this form and I understand and fully agree with the statements made. EMERGENCY CARE: In case of emergency if parent or guardian cannot be reached, I hereby grant permission for the local Emergency Department to provide urgent medical treatment for my child, including sutures and X-rays, if necessary. NOTE: YOU MUST AGREE TO THESE TERMS IN ORDER TO REGISTER! Check the box below before proceeding.
(*)	Yes, I agree Invalid Input

	Parent and Guardian Information:
Parent/Guardian Contact Name: (*)	Please enter your full name.
Secondary Contact: (*)	Invalid Input
E-mail (*)	Invalid email address.
Phone Number: (*)	Invalid Input
Secondary Phone (*)	Invalid Input
How Did You Hear About Us?	Invalid Input
	The next page will give you the option to choose the payment amount you will be registering for online. REMINDER: Due to limited space, we can only accept online registrations that complete the payment step. For example: You may not register for 5 sessions, but only pay for one. Only register for the session you are prepared to pay for at this time.

	Camper/Child Information:
First Name: (*)	Invalid Input
Last Name: (*)	Invalid Input
Street Address: (*)	Invalid Input
City, State, Zip: (*)	Invalid Input
Gender: (*)	Male Female Invalid Input
Any Allergies?	Yes, my child has allergies No, my child has no allergies Invalid Input
If "Yes", please elaborate on allergies:	Invalid Input
Permission to use child's photo: (*)	Yes, I give EHTPAL permission to use my child's photo in advertisements No, I do not give EHT PAL permission to use my child's photo in advertisements Invalid Input
	Sessions and Payment Selections
Registration Fee $50:	$50 One-Time Registration Fee - 50 USD $0 Waive my registration fee as I am paying in full! - 0 USD Invalid Input
Full 5 Day/Week Session $165 Per Week	Invalid Input
Confirm Your Full Session Dates:	Using the schedule on the PDF Flyer, confirm the dates/ Full sessions (or dates) you are paying for on this registration form by entering them here.
3-Day Per Week Session	Invalid Input
	You can alternatively elect to pay for single days from the dropdown list below. Up to 8 hours per day. A fee of $5 per hour for any additional time will be charged accordingly. NOTE: There is a 2 day minimum for registration.
Single Days ($42 Each)	Invalid Input
Confirm Your Single Day Dates:	Using the schedule on the PDF Flyer, confirm the dates/ days (or dates) you are paying for on this registration form by entering them here.

	Please confirm the total (below) before clicking the "Submit" button.
	Once you've submitted this form, you will receive an email transcript with a recap of the information you've added and paid for online. Please make sure you have entered the dates, days you're paying for on the previous page prior to submitting this form.
Your total:	0 USD

	NOTICE: Sessions 1, 2, 3, 4 due by April 1st Sessions 5, 6, 7, 8 due by May 1st Sessions 9, 10 due by June 1st Any payments not received by the due date for each session, can result in a forfeit of the camper’s space.

Summer Camp Registration/Payments

Introduction and Information:

Parent and Guardian Information:

Camper/Child Information:

Sessions and Payment Selections

Please confirm the total (below) before clicking the "Submit" button.