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Camp Week

Select One Or More Camp Weeks: Week 1: June 5th – June 9th, Week 2: June 12th – June 16th

Camper Information

Name: Philip Stefan Man

Age: 7

Grade Going Into: 2nd grade

School Name: Questfield school

Address: 11007 mill creek way
1505
Ft myers, Florida 33913

Parent/Guardian Information

Name: Maria Man

Primary Phone: 2393179217

Secondary Phone:

Email: marinamihaila@hotmail.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