CSBC

Catholic Schools of Broome County Logo

2022 Summer Enrichment Camp
June 27 - July 1
July 5-8*
July 11-15

8:00-3:00 pm
@ SCC

Wacky Wednesdays

June 29
K-2 - Field trip to Animal Adventure
3-6 - Field trip Bemont Billings Farmstead

July 6
K-2 - Field trip to the Discovery Center
3-6 - Field trip to Animal Adventure

July 13
Kopernik will bring the Wacky Wednesday fun to SCC!

All campers will receive a CSBC Summer Camp T-Shirt

Non CSBC Families - $175 per week (prior to June 1) / $200 (starting June 1)

*Cost for the July 4 week is $140, due to camp being closed for the holiday.

REGISTRATION

How many campers are you registering?

Camper #1 First Name:

Camper #1 Last Name:

Camper #1 - School:

Camper #1 Grade (fall 2022):

Camper #1 T-Shirt Size:

Camper #1 - June 27 - July 1 Registration

$200 • 1 Item Limit

Hit plus sign to register

Camper #1 - I give my son/daughter permission to attend the Wacky Wednesday field trip to: Animal Adventure (K-2) or Bemont Billings (3-6)

Camper #1 - July 5-8 Registration

$160 • 1 Item Limit

Hit plus sign to register

Camper #1 - I give my son/daughter permission to attend the Wacky Wednesday field trip to: Discovery Center (K-2) or Animal Adventure (3-6)

Camper #1 - July 11-15 Registration

$200 • 1 Item Limit

Hit plus sign to register

Camper #2 First Name:

Camper #2 Last Name:

Camper #2 - School:

Camper #2 Grade (fall 2022):

Camper #2 T-Shirt Size:

Camper #2 - June 27 - July 1 Registration

$200 • 1 Item Limit

Hit plus sign to register

Camper #2 - I give my son/daughter permission to attend the Wacky Wednesday field trip to: Animal Adventure (K-2) or Bemont Billings (3-6)

Camper #2 - July 5-8 Registration

$160 • 1 Item Limit

Hit plus sign to register

Camper #2 - I give my son/daughter permission to attend the Wacky Wednesday field trip to: Discovery Center (K-2) or Animal Adventure (3-6)

Camper #2 - July 11-15 Registration

$200 • 1 Item Limit

Hit plus sign to register

Camper #3 - First Name:

Camper #3 - Last Name:

Camper #3 - School:

Camper #3 Grade (fall 2022):

Camper #3 T-Shirt Size:

Camper #3 - June 27 - July 1 Registration

$200 • 1 Item Limit

Hit plus sign to register

Camper #3 - I give my son/daughter permission to attend the Wacky Wednesday field trip to: Animal Adventure (K-2) or Bemont Billings (3-6)

Camper #3 - July 5-8 Registration

$160 • 1 Item Limit

Hit plus sign to register

Camper #3 - I give my son/daughter permission to attend the Wacky Wednesday field trip to: Discovery Center (K-2) or Animal Adventure (3-6)

Camper #3 - July 11-15 Registration

$200 • 1 Item Limit

Hit plus sign to register

Camper #4 First Name:

Camper #4 Last Name:

Camper #4 - School:

Camper #4 Grade (fall 2022):

Camper #4 T-Shirt Size:

Camper #4 - June 27 - July 1 Registration

$200 • 1 Item Limit

Hit plus sign to register

Camper #4 - I give my son/daughter permission to attend the Wacky Wednesday field trip to: Animal Adventure (K-2) or Bemont Billings (3-6)

Camper #4 - July 5-8 Registration

$160 • 1 Item Limit

Hit plus sign to register

Camper #4 - I give my son/daughter permission to attend the Wacky Wednesday field trip to: Discovery Center (K-2) or Animal Adventure (3-6)

Camper #4 - July 11-15 Registration

$200 • 1 Item Limit

Hit plus sign to register

Camper #5 First Name:

Camper #5 Last Name:

Camper #5 - School:

Camper #5 Grade (fall 2022):

Camper #5 T-Shirt Size:

Camper #5 - June 27 - July 1 Registration

$200 • 1 Item Limit

Hit plus sign to register

Camper #5 - I give my son/daughter permission to attend the Wacky Wednesday field trip to: Animal Adventure (K-2) or Bemont Billings (3-6)

Camper #5 - July 5-8 Registration

$160 • 1 Item Limit

Hit plus sign to regsiter

Camper #5 - I give my son/daughter permission to attend the Wacky Wednesday field trip to: Discovery Center (K-2) or Animal Adventure (3-6)

Camper #5 - July 11-15 Registration

$200 • 1 Item Limit

Hit plus sign to register

PARENT / GUARDIAN INFORMATION

First Name

Last Name

Mobile Number

Address

City

State

Zip

EMERGENCY CONTACT / MEDICAL INFORMATION

Emergency Contact Name #1 (First and Last Name):

Emergency Contact #1 Phone:

Emergency Contact #1 - Relationship to Camper

Emergency Contact #2 (First and Last Name):

Emergency Contact #2 Phone:

Emergency Contact #2 - Relationship to Camper

Do any of the campers registered have any medical/dietary concerns (i.e. allergies, gluten, asthma, etc.) we need to be aware of:

If yes, please list the name of the camper(s) and all medical/dietary concerns below:

255 character limit

0 / 255

MARKETING RELEASE

I give permission to take photos and or video of my son or daughter while at camp to use in future marketing promotions for the CSBC.

I would like to make a donation to the summer camp program:

Donations to the summer camp program allow more children to attend summer camp by providing scholarships to campers who need assistance with camp registration fees.

This is a secure 256-bit SSL encrypted payment

Card Number

Expiration Date

CVV

I would like to cover the payment processing fee.

Donor hereby approves the payment of the charitable donation and/or purchase to Catholic Schools of Broome County and in the amount set forth herein.