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Camp Week

Select One Or More Camp Weeks: Week 2: June 12th – June 16th

Camper Information

Name: Mykhailo Chamata

Age: 13

Grade Going Into: 6

School Name: De Lasalle Academy

Address: 2210 Malibu Lake Way Apr 823
Naples, FL 34119

Parent/Guardian Information

Name: Olena Chamata

Primary Phone: 3524426281

Secondary Phone:

Email: alena.chamata@gmail.com

Relationship To Child: mother

Does Your Child Need a Modification / Accommodation? Yes

Please Describe The Need:

We don’t have a surfboard.Or maybe something else is needed

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