BASE Summer Camp Registration

Parent Contact Information:

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Address Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Email REQUIRED Please fill out this field. Please enter an email address.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Preferred language for communication: English Spanish

Preferred method of contact: Email Phone

Child's Name Please enter valid data.

Grade entering Fall 2022

Single Camper day(s) needed: Please enter valid data.

Child's Name Please enter valid data.

Grade entering Fall 2022

Single Camper day(s) needed: Please enter valid data.

Child's Name Please enter valid data.

Grade entering Fall 2022:

Single Camper day(s) needed: Please enter valid data.

Child's Name Please enter valid data.

Grade entering Fall 2022

Single Camper day(s) needed: Please enter valid data.