2018 Summer Camp Registration Form

Please use this form to register for the FREE Summer Camp at The Bridge Community Center.  

Camp will begin Monday, July 23rd and end on Friday, July 27th.  Everyday camp will start at 12:30pm and end at 3:30pm. Camp is for any student in grades K-6th. 

BELOW IS A MEDICAL & PHOTO AND CHILD WAIVER FORM  THAT MUST BE FILLED OUT BY A GUARDIAN TO BE KEPT ON FILE.  FORMS ARE AVAILABLE AT THE BRIDGE AS WELL.

 Any questions about this program please contact Arnie Buehler.

              E-Mail: thebridgejc@gmail.com     Phone #: 607-206-1930

Section One:
Child Information: *
Child Information:
Section Two:
Parent/Guardian Information: *
Parent/Guardian Information:
Best Phone Number *
Best Phone Number
Please specify others who are able to pick-up your child and their relationship to them:
Please specify others who are able to pick-up your child and their relationship to them:
Phone Number
Phone Number
Please specify others who NOT able to pick-up your child and their relationship to them:
Please specify others who NOT able to pick-up your child and their relationship to them:
Phone Number
Phone Number
If no it will be assumed that you or another specified adult will drop off and pick up everyday.
My child may walk home with an older child:
My child may walk home with an older child:

Other Forms Needed for Camp:

Medical Form

Photo Release