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Camp Week

Select One Or More Camp Weeks: Week 3: June 19th – June 23rd

Camper Information

Name: Chase Gilbert

Age: 6

Grade Going Into: 1st

School Name: Royal Palm Academy

Address: 27683 Bay Point Ln
Bonita Springs, FL 34134-3917

Parent/Guardian Information

Name: Lacy Gilbert

Primary Phone: 2392186071

Secondary Phone:

Email: lacygilbertdmd@gmail.com

Relationship To Child: Mother

Does Your Child Need a Modification / Accommodation? Yes

Please Describe The Need:

He will just need assistance to put his earplugs in when going in the water

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