Winter Day Camp

Please select one to get started*

New registration for the 2022-2023 Winter Camp
Returning for additional days/weeks for the 2022-2023 Winter Camp

Child Information

First Name*

Last Name*

Current Grade Level*

Photographs & Videos

I authorize Ararat Winter Camp Staff to photograph my child during his/her camp activities and share these photos with other families as part of documentation of activities.

Photographs & Videos*

Yes
No

Consent for Medical Treatment

As the parent/legal guardian, I hereby give consent to HOMENETMEN GLENDALE "ARARAT" CHAPTER to seek all emergency dental or medical care prescribed by duly licensed physician (M.D.) or dentist (D.D.S.) for our child in case of illness or accident when neither parent can be located. This care may be given under whatever conditions are necessary to preserve the life, limb or well being of my dependent.

Child's Name*

Parent/Guardian's Name

Child has the following medication/food allergies

Parent Information

Mother's Name*

First Last

Phone Number*

Father's Name*

First Last

Phone Number*

Email*

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Emergency Contact

if parent is not available

Name*

Relationship to Child*

Phone Number*

Winter Camp Dates

December 26-January 4

Individual Dates

Select Individual Dates*

December 26
December 27
December 28
December 29
December 30

Payment Info

Billing Address*

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

Grand Total

$0.00

Terms & Conditions*

I agree to the terms and conditions of Ararat Winter Day Camp. (click to view)