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Camp Week

Select One Or More Camp Weeks: Week 5: July 3rd – July 7th (4 day week)

Camper Information

Name: Antonella Kerner

Age: 7

Grade Going Into: Second grade

School Name: Morikami park elementary

Address: 2472 waterside Dr
Lake Worth Beach, FL 33461

Parent/Guardian Information

Name: Vanessa Kerner

Primary Phone: 5617794856

Secondary Phone:

Email: vanessadonaire@mac.com

Relationship To Child: Mother

Does Your Child Need a Modification / Accommodation?

Electronic Signature: I agree to send my child to Ocean Kids Camp

Name Of Person(s) Allowed To Pick Up Child

Name Of Person(s) NOT Allowed To Pick Up Child

Payment

Total Cost ($200/Week): 0.00

Scholarship#: Okc23