Camp Registration Form – Willows Swim Club

Willows Membership(Required)

Bonded Member

Non-Bonded Member

Not a Member of the Willows

Child #1 Information

Child #1 Name(Required)

First Last

Child #1 Age(Required)

Any medical conditions (ex. asthma, use of epi pen, allergies)(Required)

If none please enter N/A

Child #2 Information

Child #2 Name

First Last

Child #2 Age

Any medical conditions (ex. asthma, use of epi pen, allergies)

If none please enter N/A

Guardian Details

Guardian Name(Required)

First Last

Guardian Email(Required)

Enter Email Confirm Email

Guardian Phone(Required)

Before/After Care Registration

Camp Hours are 10:00am-3:00pm. We are offering before care from 9:00-10:00am ($30/week/per child), and after care from 3:00-5:00pm ($40/week/per child). If you are not interested in before or after care you can click next on the bottom of the screen.

Before Care (9:00-10:00am)

1 Child

2 Children

N/A

How many weeks of before care

After Care (3:00-5:00pm)

1 Child

2 Children

N/A

How many weeks of after care

Subtotal

$0.00

Payment Details

Please choose ACH or Credit/Debit for payment. We do not accept payment at the door, therefore no cash or checks.

Bonded Member Discount (40% off)

$0.00

Bonded Members: $150 Non Bonded & Non Members: $250 Theatre Week is an additional $50 for everyone

Total

ACH

Account Number Account Type Routing Number Account Holder Name

Credit Card

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Name

First Last

Name

First Last

Order Token

Join Us for Camp Willows this Summer!

2026 Willows Camp Registration

Child #1 Information

Child #2 Information

Guardian Details

Camp Registration

Before/After Care Registration

Payment Details