Summer Camp Registration

Parent/Guardian Information

Name*

First Last

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Enter Email Confirm Email

Note: We are offering a shuttle bus service between Madison/Middleton and Mazomanie! Find out more here.

Student Information

Registered Students

Name	Age	Camp Week	Actions
			Edit Delete
There are no students.

Maximum number of students reached.

Number of students

Calculate the number of students. Is this necessary?

Total of Number from Child Form

This calculates the number of weeks/students registered in the child forms. The advanced camp counts as 2 weeks.

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Would you like to get our email Newsletter? (Typically > 1 email month)

Sure!
Nope
I'm already subscribed

May we use photo/video of you for future promotions?

Yes
No

Would you like us to share your contact info with other parents or class participants for carpooling purposes?

Yes
No

Payment

Registration Fee

Price: $0.00

Have you received a scholarship?

Scholarship

If you've received a scholarship enter the code here.

Scholarship Discount

$0.00

Scholarship Discount

$0.00

Scholarship Discount

$0.00

Scholarship Discount

$0.00

Pay Deposit or in Full?

Pay in Full
Pay Deposit

Remaining Balance Due

Price: $0.00

Remaining Balance Due

Price: $0.00

Total Due

$0.00

How would you like to pay?

PayPal
Credit Card
Check

Convenience Fee

Price: $2.00

Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Summer Circus Camp Registration

Parent/Guardian Information

Student Information

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Payment