Wayne PAL 2024 Summer Day Camp Registration

Camper Information

First and Last Name *

Address *

City *

State *

Zip *

Date of Birth * +

Adult Email Address *

Phone *

Gender *

Male

Female

T-Shirt Size *

School Information

School *

Grade (as of September 2024) *

Parent/Guardian Information

Relationship to the Camper *

Parent

Guardian

Other

Name *

Emergency Phone *

Employer *

Work Phone *

Work E-Mail Address (Leave blank if same as above)

Camper Medical Information

Pediatrician Name *

Pediatrician Phone *

Dentist Name *

Dentist Phone *

Current Immunization Records Must be on File with the Wayne PAL prior to the first day of camp

Please indicate any Allergies

If your child requires medication to be taken on a daily basis, please list them below

Camp

We offer a variety of options for camp. Our normal day is from 7:00am-6:30pm for $230 per week and we have are early dismissal which is 7:00am-3:30pm which is $200 per week. We also offer a daily registration which specific dates must be indicated one week in advance for $50 per day

Check Weeks Attending

Full Day 7:00am-6:30pm

Week 1 - June 24th - June 28th ($230.00)

Week 2 - July 1st - July 3rd ($150.00)

Week 3 - July 8th - July 12th ($230.00)

Week 4 - July 15th - July 19th ($230.00)

Week 5 - July 22nd -July 26th ($230.00)

Week 6 - July 29th- August 2nd ($230.00)

Week 7 - August 5th -August 9th ($230.00)

Week 8 - August 12th -August 16th ($230.00)

Week 9 - August 19th - August 23rd ($230.00)

Check Weeks You Are Paying for at this time

Full Day 7:00am-6:30pm

Week 1 - June 24th - June 28th ($230.00)

Week 2 - July 1st - July 3rd ($150.00)

Week 3 - July 8th - July 12th ($230.00)

Week 4 - July 15th - July 19th ($230.00)

Week 5 - July 22nd-July 26th ($230.00)

Week 6 - July 29th- August 2nd ($230.00)

Week 7 - August 5th -August 9th ($230.00)

Week 8 - August 12th -August 16th ($230.00)

Week 9 - August 19th - August 23rd ($230.00)

Check Weeks Attending

Early Day - 7:00am-3:30pm

Week 1- June 24th - June 28th ($200.00)

Week 2 - July 1st - July 3rd ($120.00)

Week 3 - July 8th - July 12th ($200.00)

Week 4 - July 15th - July 19th ($200.00)

Week 5 - July 22nd -July 26th ($200.00)

Week 6 - July 29th- August 2nd ($200.00)

Week 7 - August 5th -August 9th ($200.00)

Week 8 - August 12th -August 16th ($200.00)

Week 9 - August 19th- August 23rd ($200.00)

Check Weeks You Are Paying for at this time.

Early Day - 7:00am-3:30pm

Week 1- June 24th - June 30th ($200.00)

Week 2 - July 1st - July 7th ($120.00)

Week 3 - July 8th - July 12th ($200.00)

Week 4 - July 15th - July 19th($200.00)

Week 5 - July 22nd -July 26th ($200.00)

Week 6 - July 29th - August 2nd ($200.00)

Week 7 - August 5th -August 9th ($200.00)

Week 8 - August 12th -August 16th ($200.00)

Week 9 - August 19th- August 23rd ($200.00)

Office Use Only

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Daily Campers do not register in advance. Just walk-up the day you wish to attend. Please bring immunization records at that time along with payment. Cash, check and credit cards accepted.

I hereby give consent for my child to participate in the Wayne PAL Summer Day Camp. I assume all risks in regard to participationin the Wayne PAL Summer Day Camp and I release, indemnify and agree to hold harmless the Wayne Police Athletic League Inc and its officers, coaches, counselors, camp director and volunteers from any liability that may result from participation. By agreeing I attest that all information submitted is correct and that in the event of a medical emergency, I authorize the Wayne PAL to seek emergency medical care for my child as deemed necessary by a professional EMT.

Signature (Use Mouse) *

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