Summer Camp

BUSHIKAN WINTER BREAK CAMP
January 6 ~ 10, 2025

PARENT/GUARDIAN INFORMATION

* Indicates a required field

* Name :

* Last Name :

* Address :

* City :

* State :

* Zip Code :

* Cell Phone # :

Work Phone # :

* E-mail :

Emergency Contact :

Emergency Phone #:

WINTER BREAK CAMP FEES

*Fees are not refundable

1st Child $249 * 2nd Child $224 * 3rd Child $199

1st CHILD INFORMATION

* Full Name: * Age:

* School: * Camp Fees 1:

Illness/Injuries? :

2nd CHILD INFORMATION

* Full Name: * Age:

* School: * Camp Fees 2:

Illness/Injuries? :

3rd CHILD INFORMATION

* Full Name: * Age:

* School: * Camp Fees 3:

Illness/Injuries? :

Total Amount :

CLICK ON SEND TO MAKE A SECURE PAYMENT