Good Samaritan Summer Camp Registration

This form can be used to register up to 3 campers as long as they are attending the same camps and share the same parent and approved pick up information.

Camper Information

If you selected '"YES" please explain in the box below.
If you selected '"YES" please explain in the box below.
If you selected '"YES" please explain in the box below.

Please select the weeks/months you would like your camper(s) to attend below

Parent Information

Mom's Information

Dad's Information

Approved Pick Up List

Please list the people approved to pick up your child below. Government issued, picture ID required at pick up.

To acknowledge that you understand, agree and consent to the terms and conditions above, please type "YES" into the following box and then click the "I agree" button to proceed with registering.