Hollis Crossings Summer Day Camp 2022

We are so excited you have chosen to share your camper with us this summer.
We can't wait to welcome them to Hollis!

To register your camper(s) for one or both sessions of Hollis Crossings Summer Day Camp, please choose the session and remit payment.

Hollis Crossings Summer Day Camp is a fun, active and faith-filled week during the summer for children grades K-5.
During the week, kids run, play, jump, explore the outdoors and make new friends…while experiencing God love for all.
Hollis receives both staff and program from Camp Tomah Shinga , an accredited camp with Lutheran Outdoor Ministries.

Cost to attend camp is $85/camper
$75 for each additional camper from same family

*$90/camper after June 1st for Session 1 & July 1 for Session 2

Eligible Campers are kids who have completed grades
Kindergarten-5th grade.
When asked for grade, please indicate the grade camper will have just completed during 2021-2022 school year.

Contact us with questions.
(913) 441-0451 | info@holliscenter.org | www.holliscenter.org

*Please gather all relevant information before starting this form. The page may time out after 15-20 minutes and your entry will not be saved.*

Day Camp Registration

Camp Session	Price	Total
One Camper - Session #1 (June 6-9)	$85.00	$0.00
Additional Camper(s) for Session 1	$75.00	$0.00
Select quantity of additional campers attending Session 1 only
One Camper - Session # 2 (July 11-14)	$85.00	$0.00
Additional Camper(s) for Session 2	$75.00	$0.00
Select quantity of additional camper(s) attending Session 2 only
One Camper - Both Sessions (June 6-9 & July 11-14)	$170.00	$0.00
Additional Camper(s) attending both sessions	$150.00	$0.00
Select quantity of additional camper(s) attending both sessions
		Total: $0.00
×Promotion code has been applied successfully. Add a promotion code The promotional code is not valid. Please enter a promotional code.

List of the Additional Campers added to the registration.

#	First Name	Last Name	Edit

Click here to add Additional Campers

Total Amount Due: $0.00

Primary Parent/Guardian

First Name *

Last Name *

Business Name

Email *

Phone *

Address Line 1 *

Address Line 2

City *

State *

Zip *

Country / Region

Camper #1 Information

Please fill this out for your camper. If you are registering more than 1 camper, please select the "Click here to add additional campers" button to provide information on any additional campers.

Is Guardian above responsible for transport? * The field Is Guardian above responsible for transport? is required.

Secondary Transportation Contact * The field Secondary Transportation Contact is required.

Secondary Transportation Contact Phone # * The phone field Secondary Transportation Contact Phone # is required.

Emergency Contact * The field Emergency Contact is required.

Emergency Contact Phone * The phone field Emergency Contact Phone is required.

Emergency Contact Email * The email field Emergency Contact Email is required.

Medical Insurance Company & Policy Number The maximum length for the field Medical Insurance Company & Policy Number is 500 characters.

Name & Contact Number of Family Doctor The maximum length for the field Name & Contact Number of Family Doctor is 500 characters.

Preferred Hospital The maximum length for the field Preferred Hospital is 500 characters.

Camper First Name * The field Camper First Name is required.

Camper Last Name * The field Camper Last Name is required.

Camper Birthday * The date field Camper Birthday is required.

Grade * The field Grade is required.

Gender * The field Gender is required.

T-Shirt Size * The field T-Shirt Size is required.

Known allergies and/or dietary restictions The maximum length for the field Known allergies and/or dietary restictions is 5000 characters.

Medications being taken OTC or prescribed The maximum length for the field Medications being taken OTC or prescribed is 5000 characters.

Medical History

Medical History Explanations The maximum length for the field Medical History Explanations is 5000 characters.

Physical restrictions of camper The maximum length for the field Physical restrictions of camper is 5000 characters.

Any additional information about camper The maximum length for the field Any additional information about camper is 5000 characters.

PERMISSION TO ADMINISTER MEDICATION * The field PERMISSION TO ADMINISTER MEDICATION is required.

AUTHORIZATION FOR MEDICAL TREATMENT * The field AUTHORIZATION FOR MEDICAL TREATMENT is required.

AUTHORIZATION TO PARTICIPATE * The field AUTHORIZATION TO PARTICIPATE is required.

PHOTO/VIDEO RELEASE * The field PHOTO/VIDEO RELEASE is required.

DIGITAL SIGNATURE * The field DIGITAL SIGNATURE is required.

How did you hear about Hollis Crossings * The field How did you hear about Hollis Crossings is required.

I have read the authorizations and indicated my choices above. * View Waiver Initials: *

Additional Comments

PERSMISSION TO ADMINISTOR OTC MEDICATION

Day Camper Information

Hollis Crossings Summer Day Camp 2022

Day Camp Registration

Primary Parent/Guardian

Camper #1 Information

Your Payment Method

Your Billing Information

Your Payment Information