LOY Summer Camp Registration Form 2025

Loving Our Youth Summer Camp 2025

Ages: 4-14 years old
Director: Briana Peterson Email: lovingouryouth89@gmail.com Ph:410-800-8498
Scholars Name:

First NameLast Name
Birth Date

MonthDayYear
Current Grade
MaleFemale
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Home Number
Format: (000) 000-0000.
Cell Number
Format: (000) 000-0000.
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
Does the scholar have any allergies, chronic illness, or medical conditions? If yes, please describe.
Once you've submitted a form, I will contact you to submit your child's registration fee. Please note, all registration fees are non refundable. Thank you!
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date

MonthDayYear
Date
Signature

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My Products

Registration Fee

Please note, registration fee goes towards MOST of your child's weekly field trips and camp T-shirt. Registration fee is due by June 10th, 2025. Fee is not due at time of registration; however, your child's payment will guarantee his/her spot. (Includes $5.00 Square Processing Fee) Please note, if you register after 6/5,please call 410-800-8498 to ensure that spots are still available. Thank you!

$180.00

Total

$0.00

Credit Card

Name

First NameLast Name
Should be Empty:

Loving Our Youth Summer Camp 2025

Director: Briana Peterson Email: lovingouryouth89@gmail.com Ph:410-800-8498

Credit Card