Welcome Campers!
Camp Sunshine Camper Registration 2018

After completing this registration form, you will be asked to print out our Health Form, which will need to be sent to us by mail.
What is the Campers first & last name? *

Camper's Gender

What is the camper's age? *

What is the Camper's date of birth?   (month/day/year) *

Identity of camper: Please pick the following that best describes your camper. *

Information about camper. Click all that applies. *

First time Camp Sertoma camper?

What size of shirt does the Camper wear? *

All sizes being assumed adult.

What is the first & last name of the Parents/Guardians? *

Address *

Street / City / State / Zip Code
Parent/Guardian's Phone Number? (xxx) xxx-xxxx Mark number(s) with Voice/Text/or both so we know how to contact you. *

If you are not available in an emergency notify:

Emergency Contact #1 *

Please state Name // Phone // Relationship
Emergency Contact #2 *

Please state Name // Phone // Relationship
Please provide any additional information about the camper that may be helpful for the camper to have a successful camp experience!

As custodial parent/guardian, I designate all matters of discipline and emergencies to camp authorities and release the camp supervisors, the YMCA, and Sertoma Clubs of St. Joseph for liability for accidents. I understand that if a serious injury or illness develops, medical or hospital care will be given and I will be notified. However, it it is impossible to reach me, I give permission for emergency treatment, x­-rays, or surgery as recommended by the attending physician and camp staff(s). *

I understand my child may be photographed during camp, through activities and field trips. I give my permission to use these photos for advertising, TV, and social media exposure to promote the Sertoma Clubs of St. Joseph Summer Camp (Camp Sunshine). *

Payment and Camp Information

Camp Registration fee: $175 total.

$100 dollars down payment is due with registration to reserve your child's spot at camp. After payment is made, it is non-refundable.

Remaining balance of $75 will be due by May 31st, 2018.

After May 31st, the cost will go up $25.

Please Make Checks Payable to: The Sertoma Clubs

Checks may be mailed to:
Camp Sunshine
Attn: Beth Beadle, Camp Director
1601 W. Brittany Street
Olathe, KS 66061

Thank you for filling out the registration form. Please print out the Health Form found on our website, complete and send it with your payment and copy of your health insurance card.
AGREEMENT:  By signing this Electronic Signature Acknowledgment Form, I agree that my electronic signature is the legally binding equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. I will not, at any time in the future, repudiate the meaning of my electronic signature or claim that my electronic signature is not legally binding. *

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