EmailMe Form - GCSP - Summer Camp Registration Form

Child's Information

Child's Name *

First Last

(Please use a separate form for each child)

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Child's Date of Birth *

MM / DD / YYYY

Child's Age *

Child's Gender *

Boy

Girl

Other

Does the child have any medical concerns of which we should be aware? *

Who will be picking up the child?

Guardian's Contact Information

Guardian's Name *

First Last

Relationship to Child *

Guardian's Cell Phone *

### - ### - ####

Guardian's Email *

Payment Information

How do you intend to pay for the Summer Camp? *

Check

PayPal

If paying with a check, please enter the check number above.
Please make checks payable to the Garden Club St. Petersburg and mail checks to:
Youth summer Camp, 500 Sunset Drive, St. Petersburg, Florida 33707-1136

Applying for a scholarship? *

Yes

No

Other Information

How did you hear about the Garden Club's Summer Camp? *

Please read and sign below.

By your signature below, you give permission and acknowledge that photographs and/or video may be taken of your child and that The Garden Club of St. Petersburg may use such media and/or likenesses in print, on the Internet, and/or for training purposes. If you have an objection to the use of your child’s image, please contact The Garden Club of St. Petersburg before completing this form.

Please print your full name *

Date Time *

MM / DD / YYYY

Signature *

Clear

After clicking the "Submit" button please wait as sometimes it will take a moment before you are automatically redirected to PayPal. Remember is you wish to pay by check, simply close the PayPal window and submit your check to the Garden Club. Please only click the "Submit" button once.

**To avoid duplicate submissions, please only click "Submit" once. It may take a moment for the form to process and move to the next page.**