Summary Camp

Registration Form - Chinmaya Summer Camp 2023

30877 N. Fairfield Rd, Grayslake, IL 60030

847-740-1215

2 Week Youth Camp for Grades 1-8

Week 1: June 12th-16th 8:30 am - 4:30 pm

Week 2: June 19th-23rd 8:30 am - 4:30 pm

Camp Registration Fees per Child: $750

Parent's Information [Either Mother's or Father's info.]

* Last Name:

* First Name:

* Addr1:

Addr2:

* City/State:

* ZipCode:

* Relation to Child:

Father Mother

Volunteer at Camp:

Yes No

* Email

* Home/Cell Phone

* Emergency Contact:

* Emergency Phone:

Do you need help with transportation?:

Yes No

Are you willing to help with carpooling if necessary?:

Yes No

Student 1 Information

* Last Name:

* First Name:

* Date of Birth

* Gender:

Male Female

* Grade In Sep 2023:

Attending

* Pediatrician Name

* Pediatrician Phone:

* Medical Info:

* Food/Drug Allergies:

Student 2 Information

* Last Name:

* First Name:

* Date of Birth

* Gender:

Male Female

* Grade In Sep 2023:

Attending

* Pediatrician Name

* Pediatrician Phone:

* Medical Info:

* Food/Drug Allergies:

Student 3 Information

* Last Name:

* First Name:

* Date of Birth

* Gender:

Male Female

* Grade In Sep 2023:

Attending

* Pediatrician Name

* Pediatrician Phone:

* Medical Info:

* Food/Drug Allergies: