Redwood Summer Camp Sign Up

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NOTE: Summer Camp reservations are currently full; to be placed on a wait list, please contact Lila at office@santacruzwaldorf.org

Questions regarding camp? Please contact Nori at norian.valencia@santacruzwaldorf.org

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Registration

Please select the weeks you would like your children to attend camp and aftercare.

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Questions?
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Summer Camp Registration Form 2023-2024

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Your Info

1st Parent's Name (First, Last)*

1st Parent's Daytime Phone*

2nd Parent's Name (First/Last)

2nd Parent's Daytime Phone

1st Parent's Cell Phone*

1st Parent's Email Address*

2nd Parent's Cell Phone

2nd Parent's Email Address

Other Contacts (in case of Emergency) Please include first name, last name and phone number*

Address, line 1*

Address, line 2

City*

State*

Zip Code*

Preferred first name of student #1*

Student #1 Grade*

Last Name*

List allergies, medical conditions for Student #1

Please list all medications used daily by student #1 (please include prescription and/or over-the-counter)

Insurance Company & Medical Record Number if applicable (student #1):*

Physician Name for Student #1*

Physician's Phone for student #1*

Preferred first name of student #2

Last name

List allergies and other medical conditions for student #2

Student #2 Grade

Please list all medications used daily by student #2 (please include prescription and/or over-the-counter)

Insurance Company & Medical Record Number if applicable (Student #2)

Physician name (Student #2)

Physician's Phone # (Student #2)

Preferred first name of student #3

Last name-

Student #3 Grade

List allergies and other medical conditions for student #3

Please list all medications used daily by student #3 (please include prescription and/or over-the-counter)

Insurance Company & Medical Record Number if applicable (student #3)

Physician Name (Student #3)

Physician's Phone # (Student #3)

Payment Details

Payment Type:

Credit Card

eCheck

PayPal

Bank Account*

Name on Account*

Bank Routing Number*

Bank Account Number*

Card Number*

Security Code*

Expiration Month*

Expiration Year*

Name on Card*

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See you at camp!

Thank you for registering to join us at Redwood Summer Camp 2023! A purchase receipt will arrive in your inbox shortly.

Questions?
Email or call

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