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 PaymentSTEAM June 1-5 Price: $175.00 Quantity: Use the quantity field to enter the total number of children that you would like to register for each camp.SPACE Camp June 8-12 Price: $175.00 Quantity: Use the quantity field to enter the total number of children that you would like to register for each camp.Sibling Discount CPCP offers a $25 discount to any parent who is registering siblings for camp. To take advantage of this offer simply enter the coupon code SIBLING and click apply! If you are registering multiple siblings you may reenter the coupon code for each sibling being registered. Use of this coupon is strictly on the honor system.Total $0.00 NotesBefore you check out, is there anything else that we need to know?Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name EmailThis field is for validation purposes and should be left unchanged.