Camper Name: *
Camper's Date of birth: *
Campers Sept. 2016 Grade level:
Parent's Name: *
Address: *
Phone: *
E-mail: *
In consideration of participating in the City Builders Summer Camp on July 18th - 22nd, 2016, I warrant and agree that my child registered for camp is physically able to participate and I fully appreciate the potential risk of injury. I agree to indemnify and hold harmless St. Petersburg Museum of History, Pinellas County Schools, St. Petersburg College, St. Petersburg Preservation, Historic Old Northeast Neighborhood Association, and camp instructors from any and all claims, demands, damages, costs, expenses, loss of services, actions, and causes of actions arising from the participation in the City Builders Summer Camp: *
Camp tuition is $195. A deposit of $100 is due now, and the balance is due by June 1st, 2016. You can choose how much to pay below.
Camp tuition: *

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