2017 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 10th and end on Friday, July 14th.  Everyday camp will start at 12:30pm and end at 3:30pm. Camp is for any student in grades K-6th. 

 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