Online Payments Camp Registration Form

Online Registration & Payment Form

Please note that there is a 3.98% transaction fee already added on prices listed below for online payments.
Today's Date*

MonthDayYear
Parent/Guardian Information
Parent/Guardian's Name*

FirstLast
Email*
Cell Phone #*
Format (401) 999-9999
Summer Address*

Address Line 1

Address Line 2

CityState / Province

Postal / Zip Code
How Many Children Are You Registering?
One ChildTwo ChildrenThree ChildrenFour Children
Child #1 Name*

FirstLast
Date of Birth (BIRTHDATE MUST BE PRIOR TO 5/31/20 - NO EXCEPTIONS) Child 1*

MonthDayYear
Age (Child must be 5 or older) Child 1*
Allergies, Medical Concerns, Medications (Please list or enter None) Child 1 *
SESSIONS - Please Choose at Least One for Child 1
Payment Child 1 - $425.00
Both Weeks: 6/23 - 7/3 - $175.001st Week: 6/23- 6/27 - $90.002nd Week: 6/30- 7/3 - $90.00
Both Weeks: 7/7 - 7/18 - $175.001st Week: 7/7- 7/11 - $90.002nd Week: 7/14 - 7/18 - $90.00
Both Weeks: 7/21 - 8/1 - $175.001st Week: 7/21 - 7/25 - $90.002nd Week: 7/28 - 8/1 - $90.00
Pay by the Day - Child 1 (Price per day: $25.00)
Select one to ten days between 6/23 and 8/1. Please indicate which days below. This is subject to availability.
Please indicate single dates here. Enter between 6/23 and 8/1.
Registration for Child 2
Child #2 Name*

FirstLast
Date of Birth (BIRTHDATE MUST BE PRIOR TO 5/31/20 - NO EXCEPTIONS) Child 2*

MonthDayYear
Child's Age (Child must be 5 or older) Child 2*
Allergies, Medical Concerns, Medications (Please list or enter None) Child 2*
SESSIONS - Please Choose at Least One for Child 2
Payment Child 2 - $425.00
Both Weeks: 6/23 - 7/3 - $175.001st Week: 6/23- 6/27 - $90.002nd Week: 6/30- 7/3 - $90.00
Both Weeks: 7/7 - 7/18 - $175.001st Week: 7/7- 7/11 - $90.002nd Week: 7/14 - 7/18 - $90.00
Both Weeks: 7/21 - 8/1 - $175.001st Week: 7/21 - 7/25 - $90.002nd Week: 7/28 - 8/1 - $90.00
Price: $25.00
Pay by the Day - Child 2 (Price per day: $25.00)
Select one to ten days between 6/23 and 8/1. Please indicate which days below. This is subject to availability.
Please indicate single dates here. Enter between 6/23 and 8/1.
Registration for Child 3
Child #3 Name*

FirstLast
Date of Birth (BIRTHDATE MUST BE PRIOR TO 5/31/20 - NO EXCEPTIONS) Child 3*

MonthDayYear
Child's Age (Child must be 5 or older) Child 3*
Allergies, Medical Concerns, Medications (Please list or enter None) Child 3*
SESSIONS - Please Choose at Least One for Child 3
Payment Child 3 - $425.00
Both Weeks: 6/23 - 7/3 - $175.001st Week: 6/23- 6/27 - $90.002nd Week: 6/30- 7/3 - $90.00
Both Weeks: 7/7 - 7/18 - $175.001st Week: 7/7- 7/11 - $90.002nd Week: 7/14 - 7/18 - $90.00
Both Weeks: 7/21 - 8/1 - $175.001st Week: 7/21 - 7/25 - $90.002nd Week: 7/28 - 8/1 - $90.00
Price: $25.00
Pay by the Day - Child 3 (Price per day: $25.00)
Select one to ten days between 6/23 and 8/1. Please indicate which days below. This is subject to availability.
Please indicate single dates here. Enter between 6/23 and 8/1.
Registration for Child 4
Child #4 Name*

FirstLast
Date of Birth (BIRTHDATE MUST BE PRIOR TO 5/31/20 - NO EXCEPTIONS) Child 4*

MonthDayYear
Child's Age (Child must be 5 or older) Child 4*
Allergies, Medical Concerns, Medications (Please list or enter None) Child 4*
SESSIONS - Please Choose at Least One for Child 4
Payment Child 4 - $425.00
Both Weeks: 6/23 - 7/3 - $175.001st Week: 6/23- 6/27 - $90.002nd Week: 6/30- 7/3 - $90.00
Both Weeks: 7/7 - 7/18 - $175.001st Week: 7/7- 7/11 - $90.002nd Week: 7/14 - 7/18 - $90.00
Both Weeks: 7/21 - 8/1 - $175.001st Week: 7/21 - 7/25 - $90.002nd Week: 7/28 - 8/1 - $90.00
Price: $25.00
Pay by the Day - Child 4 (Price per day: $25.00)
Select one to ten days between 6/23 and 8/1. Please indicate which days below. This is subject to availability.
Please indicate single dates here. Enter between 6/23 and 8/1.
Emergency Contact
Emergency Name*

First NameLast Name
Emergency Phone
Format (401) 999-9999
Waiver Section
I hereby agree to permit my child to participate in the above program sponsored by the recreation department of Bonnet Shores Fire District, its officers, directors, employees and agents (herein collectively called "the Town") upon the understanding and conditions that:

I acknowledge that the Town has advised me of the medical risks that may result in such participation and I represent to the town that I have consulted my child ' s personal physician and that my child is physically capable of such participation without injury.
• I hereby waive and release the Town from any and all claims, liabilities and expenses arising from my child' s participation in the said program with the exception of claims resulting from gross negligence or willful misconduct on the part of the Town.
• I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb or well being of my dependent.
• I hereby execute and deliver this waiver and release to induce the Town to permit my child to participate in this program.
• I hereby give permission for the Bonnet Shores Fire District Camp to use photographs for publicity, illustration, advertising and web content.
• I have read the Basic Rules for campers, have explained these rules to my child and agree to abide by these rules.
Parent/Legal Guardian - by typing in your name you consent to all the terms listed above.*
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Payment Methods

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Online Registration & Payment Form

Parent/Guardian Information

How Many Children Are You Registering?

SESSIONS - Please Choose at Least One for Child 1

Registration for Child 2

SESSIONS - Please Choose at Least One for Child 2

Registration for Child 3

SESSIONS - Please Choose at Least One for Child 3

Registration for Child 4

SESSIONS - Please Choose at Least One for Child 4

Emergency Contact

Waiver Section