JUNIOR CAMP REGISTRATION FORM
AGES 6-9 yrs. old
JUNE 16-20
| 9:00am-1:00pm
PAALS 221 N. Grampian Hills Rd. Columbia, SC 29223
Camper Information
Camper's First Name
Camper's Last Name
Address Line 1
Address Line 2
City
State
Please select...
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Island
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Parent/Guardian Name
Parent/Guardian Email
Parent/Guardian Phone number
Camper's Age
Please select...
6 years old
7 years old
8 years old
9 years old
10 years old
T-shirt size
Please select...
Youth Small
Youth Medium
Youth Large
Youth Ex-Large
Adult Small
Adult Medium
Adult Large
Adult Ex-Large
Gender
Female
Male
Other
Does the camper have any allergies?
Yes
No
Please list all known allergies here (including food and medication)
Please provide information on any chronic physical problems or pertinent developmental information or any special accommodations needed. Enter 'None' if not applicable.
Authorized person for pick up (in addition to the Emergency Contact & Parent/Guardian)
Authorized person for pick up Contact Number
Emergency Contact Information
Emergency Contact's First Name
Emergency Contact's Last Name
Relationship to Camper
Please select...
Parent
Legal Guardian
Others
Contact Number
Consent and Acknowledgement
I hereby give my approval for my child's participation in any and all activities in camp. In exchange for the acceptance of said child's candidacy by, I assume all risk and hazards incidental to the conduct of the activities, and representatives from any and all liability for injuries to said child arising out of participating in sessions at PAALS with assistance dogs in training. In case of injury to said child, I hereby waive all claims against. Including all caches and affiliates, all participants. There is a risk of being injured that is inherent in all activities. I will also complete the information packet sent to me on enrollment that will include additional questions about my child and emergency medical & insurance information in the event of accident. I will return additional forms to PAALS by June 1st.
Yes, I agree
Payment Amount
Cost for 1 camper for 1 week session is
$275.00
You may pay in full or a minimum $100 with application deposit is required to reserve a spot.
Balance ($175) is due by June 1st to secure and maintain a spot for your child.
(Balance may be submitted through general donation page with comment to indicate Balance for Camp.)
10 SPACES AVAILABLE per session FOR CAMPERS AND WILL FILL QUICKLY
Payment Options
$100 Deposit to Hold space (Balance due by June 1st)
$275 Full Payment
Payment Contact
First Name
Last Name
Name on Card
Phone
Email address
Billing Address
Street Address (Line 1)
Street Address (Line 2)
City
State
Please select...
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Island
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Payment
-
Credit Card Information
Credit Card Type
Master Card/ Visa
American Express
First Name
Credit Card Number
MM
YY
Code
Code
Final CVV Code for Connector
Contact Information