Camp Registration Step 1 of 3 33% Children*Child's Name (first, last)Childs BirthdayFriend Request (first, last) Use the plus button to register multiple children.Parents Name* First Last Home PhoneCell PhoneEmail* Your confirmation will be sent to this email. Emergency InfoEmergency Contact Name* First Last Emergency Contact Phone*Emergency Contact Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code AllergiesPlease list any allergies.Physician name and address.Please enter the names, phone numbers, and addresses for your children's physicians.InsurancePolicy NumberEmergency Medical Transportation* I consent. In emergencies requiring medical attention your child will be taken to the NEAREST HOSPITAL. By checking the "I consent" box, you authorize the responsible person at CPCP to have your child transported to the hospitalNotesPlease add any additional notes here.Photo ConsentI give consent to use photos and videos of my child.* Yes No Camp Choices Select All Stem ($200) Stem extended day ($350) Space ($200) Space extended day ($350) Stem June 7-11 (9-12 pm) Stem extended day (9-2 pm) Space June 14-18 (9-12 pm) Space extended day (9 - 2pm)PhoneThis field is for validation purposes and should be left unchanged.