Page 52 - Niles_Park_District-SummerPrograms-2025

2025 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 2025 ______________

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 2 - AuGuSt 15 (*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 6/2 - 6/6 6/9 - 6/13 6/16 - 6/20 6/23 - 6/27 6/30- 7/3 7/6 - 7/11 7/14 - 7/18 7/21 - 7/25 7/28 - 8/1 8/4 - 8/8 8/11 - 8/15
Lil Campers M-F (9a-1p)
Lil Campers M-F (9a-4p)
Lil Campers M/w/F
Lil Campers tu/th
NOT
Jr. Voyagers (Gr. K-2) AVAILABLE
NOT
Voyagers (Gr. 3-4) AVAILABLE
NOT
Explorers (Gr. 5-8) AVAILABLE
NOT
Sports Camp (Gr. K-8) AVAILABLE
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
Dance Camp (9a-3:30p) AVAILABLE AVAILABLE AVAILABLE AVAILABLE AVAILABLE AVAILABLE AVAILABLE AVAILABLE AVAILABLE
theatre Camp NOT NOT NOT NOT NOT NOT NOT NOT NOT NOT
AVAILABLE AVAILABLE AVAILABLE AVAILABLE AVAILABLE AVAILABLE AVAILABLE AVAILABLE AVAILABLE AVAILABLE
NOT
Before Care AVAILABLE
NOT
After Care AVAILABLE
RECREAtION CAMP (GRADES K - 8) EARLY CHILDHOOD CAMPS At HLC (AGES 3-6) BEFORE CARE REC/SPORtS
Fees Per Week: Res $304, Non-Res $364 Fees Per Week: (M-F 9a-1p) Res $180, Non-Res $215 Fees Per Week: Res $32, Non-Res $43
SPORtS CAMP (GRADES K - 8) (M-F 9a-4p) Res $304, Non-Res $364 AFtER CARE REC/SPORtS
Fees Per Week: Res $304, Non-Res $364 (M/W/F) Res $110, Non-Res $130 Fees Per Week: Res $62, Non-Res $78
(TU/TH) Res $75, Non-Res $87
DANCE CAMP
Fees Per Week: 9 am-3:30 pm total Fees Due $
Res $304, Non-Res $364
tHEAtRE CAMP
Fees Per Week: Res $150, Non-Res $180
CREDIt CARD INFORMAtION - (MuSt BE COMPLEtED)
Name: Exp. Date:
Card Number:
Balance Due: Signature:
MAKE SuRE tO COMPLEtE BOtH PAGES
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