Brain Chase Escape Room Summer Camp_Staker version Logo

  • Brain Chase Escape Room Camp REGISTRATION FORM

    Hosted by the Staker Family
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  • Camper #1 Information

  • NOTE - This camp is for children who will be in kindergarten through 8th grade in the 2020-21 school year.

  • Camper #2 Information

    (Skip if you are registering only one camper.)

  • NOTE - This camp is for children who will be in kindergarten through 8th grade in the 2020-21 school year.

  • Camper #3 Information

    (Skip if you are not registering a third camper.)

  • NOTE - This camp is for children who will be in kindergarten through 8th grade in the 2020-21 school year.

  • Parent/Guardian 1

  • Parent/Guardian 2

  • Emergency Contacts/Authorized Pickup

    Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. By listing this person, you give him or her authorization to pickup the child.

  • Emergency Contact

  • Medical / Health Information

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  • 0/200

  • Payment and Statement of Understanding

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          Credit Card

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