Page 52 - Niles_Park_District-Summer-Programs-2024

2024 Camp Registration Form

PLEASE COMPLETE ONE FORM (BOTH SIDES) PER CAMPER WITH SIGNED WAIVER AND RELEASE OF ALL CLAIMS

Camper’s Name (Last) ________________________________________ (First) ________________________ Birthdate ________________

Address ________________________________________________ City __________________________ Zip __________________

Parent/Guardian Name ________________________________________ Email ________________________________________________

Primary Phone ____________________________________________ Grade Entering Fall 2024 ______________

Do you need an Americans with Disabilities Act Accommodation? NO YES (Please describe any accommodations needed for successful inclusion)

Camper Information

1. Rate your child’s present swimming ability. Please circle your choice. (DOES NOT APPLY to Early Childhood Camps.)

0 1 2 3 4
No Experience Excellent Swimmer
2. Camper friend request (Not guaranteed/must be age appropriate).

3. Indicate mode of transportation leaving camp. By Parent ________ Car Pool ________ Riding Bike________ Walking________

PLEASE PUT AN X IN THE COLUMN(S) YOUR CHILD WILL BE ATTENDING CAMP: JUNE 3 - AUGUST 16 (*NO CAMP JULY 4)
WEEK 1 WEEK 2 WEEK 3 WEEK 4 WEEK 5* WEEK 6 WEEK 7 WEEK 8 WEEK 9 WEEK 10 WEEK 11
CAMP 6/3 - 6/7 6/10 - 6/14 6/17 - 6/21 6/24 - 6/28 7/1- 7/5 7/8 - 7/12 7/15 - 7/19 7/22 - 7/26 7/29 - 8/2 8/5 - 8/9 8/12 - 8/16
Lil Campers M-F (9a-1p)
Lil Campers M-F (9a-4p)
Lil Campers M/W/F
Lil Campers Tu/Th
Jr. Voyagers (Gr. K-2)
Voyagers (Gr. 3-5)
Explorers (Gr. 6-9)
Sports Camp
Mini Dance Camp (9a-1p) NOT NOT NOT NOT NOT NOT NOT NOT NOT
AVAILABLE AVAILABLE AVAILABLE AVAILABLE AVAILABLE AVAILABLE AVAILABLE AVAILABLE AVAILABLE
Full Day Dance Camp (9a-4p) NOT NOT NOT NOT NOT NOT NOT
AVAILABLE AVAILABLE AVAILABLE AVAILABLE AVAILABLE AVAILABLE AVAILABLE
Before Care
After Care
RECREATION CAMP (GRADES K - 9) EARLY CHILDHOOD CAMPS AT HLC (AGES 3-6) BEFORE CARE REC/SPORTS
Fees Per Week: Res $289, Non-Res $347 Fees Per Week: (M-F 9a-1p) Res $170, Non-Res $203 Fees Per Week: Res $30, Non-Res $41
SPORTS CAMP (GRADES K - 9) (M-F 9a-4p*) Res $289, Non-Res $347 AFTER CARE REC/SPORTS
Fees Per Week: Res $289, Non-Res $347 (M/W/F) Res $102, Non-Res $123 Fees Per Week: Res $59, Non-Res $74
(TU/TH) Res $68, Non-Res $82
DANCE CAMPS
Fees Per Week: 9 am-1 pm *EARLY CHILDHOOD BEFORE CARE Total Fees Due $
Res $170, Non-Res $203 *Before Care Option (M-F 9a-4p Camp ONLY)
9 am-4 pm Res $30, Non-Res $41 Per Week
Res $289, Non-Res $347

CREDIT CARD INFORMATION - (MUST BE COMPLETED)

Name: Exp. Date:
Card Number:

Balance Due: Signature:
MAKE SURE TO COMPLETE BOTH SIDES
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