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VBS SUMMER CAMP IS BACK!
When
: August 15th-19th
Time
: 10am - 2pm
Where
: Michael E. Reilly Fireman's Park I DeWitt Ave, Patchogue
Who
: All kids ages 4-12yrs old
Cost
: FREE!!
*
Indicates required field
Camper's Name
*
First
Last
[object Object]
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number
*
Email
*
How old is your camper?
*
Ages 4-5
Ages 6-7
Ages 8-9
Ages 10-12
Emergency Contact
*
First
Last
Emergency Contact Phone Number
*
Emergency Contact Email
*
Emergency Contact's Relationship to Camper
*
Mother
Father
Grandparent
Aunt/Uncle
Family Friend
If your child has allergies, please list them below. If not, please write N/A.
*
Would you like to be notified of other Kid's Events we have throughout the year?
*
Yes
No
For promotional purposes, pictures and/or videos of children may be taken. Please check the box below if you will or will not give consent.
*
Yes
No
Please have your camper bring the following items:
A bagged lunch
Extra bottle of water
Submit
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