Additional phone numbers, work extensions, email addresses, etc.
We permit sharing with parent approval
Your child will only be permitted to go home with the people listed on this form and will be checked in and out each day. In the case that you want your child to be able to walk home if you live downtown, be picked up by a sibling, etc please list your special requests here.
Every camper gets a Circus Culture t-shirt!
Before filling out this form, you should have signed up and paid via our Pike13 registration system. If you have not, please do that first to ensure we still have spots open!
Immunization Records & Medical Report (physical) *
I have emailed immunization records AND a medical report (physical), or an exemption request letter, and a doctor's written order and information for any medication (prescription or O.T.C.) that my child may be taking during camp to email@example.com. Be sure to name the file with your child's full name. Do it now and select yes!