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Knox Summer Adventures 2019
541 Long Beach Rd, St James, NY 11780 camp_info@knoxschool.org 631-686-1640
Camper Information
First Name
Last Name
Gender
M
F
Birth Date ex 11/22/09
*
'19-'20 Grade
Pre K
K
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
School attending '19-'20
*
Tee Shirt Size
*
Youth Sm
Youth Med
Youth Lg
Adult Sm
Adult Med
Adult Lg
Adult XL
One Buddy Request
Returning Camper?
*
Yes
No
How did you hear about us?
*
Internet Search
Friend
Backpack Flyer
Postcard
Facebook
Radio
Print Ad
Household Information
Parent/Guardian #1 First Name
*
Last Name
*
Address
*
City
*
State
*
Zip
*
Phone
*
Cell Phone
*
Email Address
*
Parent/Guardian #2 First Name
Last Name
Address if different
City
State
Zip
Phone
Cell Phone
Email Address
Emergency Contacts
Please provide contact information for 2 trusted people who have your permission to pick up your child in case of emergency in the event that we can not reach the parents listed above. Parents will always be contacted first.
Emergency Contact #1 Name:
*
Relationship to camper:
*
Home Phone:
*
Cell Phone:
*
Emergency Contact #2 Name:
*
Relationship to camper:
*
Home Phone:
*
Cell Phone:
*
Regular Rates Registration
Must register and pay in full by 6/15/19.
*Please note, any days/weeks added after 6/15/19 will be billed at the day rate.
For Credit Card:
Please Choose
*
Credit Card
Bank Account
Credit Card Type
*
Visa
MasterCard
Discover
Name on Card
*
Credit Card Number
*
Expiration Date (mm/yy)
*
CVA Code
*
For Bank Account:
Bank Account #:
Routing #:
Equestrian Programs
Equestrian Programs - Please Choose
Horse Sense 7/1-7/12
Young Riders Session 1 - 7/15-7/26
Young Riders Session 2 - 7/26-8/9
IEA 8/19-8/23
Overnight 8/12-8/16
Additional Options for Horse Sense and Young Riders
Full Day
Half Day
Stay & Play
Summer Adventures Day Camp
Please choose your schedule
Click Here for entire summer
Yes
No
Week 1
*
No Days
Thurs 6/27
Fri 6/28
CIT
Week 2 - no camp 7/4
*
No Days
Full Week
Mon 7/1
Tues 7/2
Weds 7/3
Fri 7/5
CIT
Week 3
*
No Days
Full Week
Mon 7/8
Tues 7/9
Weds 7/10
Thurs 7/11
Fri 7/12
CIT
Baracudas/Orcas Tues July 9 - Thurs July 11
Yes Six Flags - Extra $310 overnight fees apply
No Six Flags
Week 4
*
No Days
Full Week
Mon 7/15
Tues 7/16
Weds 7/17
Thurs 7/18
Fri 7/19
CIT
Week 5
*
No Days
Full Week
Mon 7/22
Tues 7/23
Weds 7/24
Thurs 7/25
Fri 7/26
CIT
Sharks/Baracudas/Orcas Weds 7/24 - Fri 7/26
Yes Club Getaway - Extra $310 overnight fees apply
No Club Getaway
Week 6
*
No Days
Full Week
Mon 7/29
Tues 7/30
Weds 7/31
Thurs 8/1
Fri 8/2
CIT
Week 7
*
No Days
Full Week
Mon 8/5
Tues 8/6
Weds 8/7
Thurs 8/8
Fri 8/9
CIT
Baracudas/Orcas Tues 8/6 - Thurs 8/8
Yes Hershey - Extra $310 overnight fees apply
No hershey
Week 8
*
No Days
Full Week
Mon 8/12
Tues 8/13
Weds 8/14
Thurs 8/15
Fri 8/16
CIT
Week 9
*
No Days
Full Week
Mon 8/19
Tues 8/20
Weds 8/21
Thurs 8/22
Fri 8/23
CIT
Click Here for Rates
Notes:
Terms & Conditions
Please sign to acknowledge you have read and agree to the terms and conditions
*
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