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BOOGIE WOOGIE WITH BAY CAMP
SPRING BREAK APRIL 14th – 18th
7:30 a.m.-6:00 p.m.
Camper’s Name: __________________________________
Age:_____________ ( camp is open to ages 5yrs- 13yrs)
Address:________________________________________
City:_________________ State:______________ Zip:_________
Mother’s Name:_____________________________DR LIC#__________________
Mother’s Phone:_____________________Mother’s Work Phone:_________________
Father’s Name:______________________________DR LIC#___________________
Father’s Phone:______________________Father’s Work Phone:__________________
Emergency Contact, Other than parents:______________________________________
Emergency Contact Phone:________________________________________________
Person for Pick Up Authorization:_______________________Relationship:__________
Insurance Company:______________Policy Holder:_____________I.D. #___________
I give my permission for my son/daughter ___________________________ to participate in
swimming, field trips, and all other activities related to the Bay Camp program. In case of
emergency, I give permission to Bay Camp to secure needed medical treatment for my
son/daughter. I also Release and Hold Harmless Bay Camp.
_________________________________________
____________________________
Parents Signature
Date
Rates: $50.00 Registration Fee
Deadline for Camp Pre-Registration is APRIL 7TH
$150.00 per child
***Please note: There is a $5.00 late fee for every fifteen minutes you are late picking up your
child from our program. Children must register for the entire week, daily rates are not available.
Once you have pre-registered you are responsible for payment in full . Payments are Non
Refundable or Transferable. (i.e. NSFs/ $30.00, Stop Payments will NOT be honored .)
****For Registrations and more information you can go to
www.easternshorebaycamp.com or call 251-752-4897
**** Registrations may be mailed to P.O. Box 6 Fairhope, Al. 36533
ATTN: Lisa Ledet Bay Camp
****Make checks payable to BAY CAMP