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Participant Information Child’s Last Name Childs First Name Date of Birth Gender: M F Participant Address City Zip Parent/Guardian Date of Birth Home Phone Cell Phone Parent Email Parent/Guardian Date of Birth Home Phone Cell Phone Emergency Contact (other than parent) Home Phone Cell Phone Camper Sign-Out Information In addition the parent/guardian listed above, my child may sign out of camp with the following person(s): 1. 3. 2. 4. My child has allergies or other special needs. It is the responsibility of the parent/guardian to provided related infor- mation about any allergies or special needs to the program coordinator. Liability/Photo Release For and in consideration of the opportunity offered to participate in the above named activity offered by the Marysville Parks and Recreation Department, I, do hereby hold harmless, release and waive all claims I or my child may have against the City of Marysville, its officials, employees, agents or contracted instructors, and any other person(s) involved in the registered activity or activities for any and all injuries, losses or damages suffered by me or my child as a result of our participation in the registered activity or activities. I accept full responsibility for the cost of treatment for any injury, losses or damages suffered. I grant to the City of Marysville, its representatives and employees the right to take photographs of me and my property in connection with the registered program. I authorize the City of Marysville, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that City of Marysville may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertis- ing and Web content. Parent/Guardian Signature Date 6915 Armar Rd., Marysville, WA 98270 - Phone [PHONE REDACTED] - Fax [PHONE REDACTED] - marysvillewa.gov Marysville Parks, Culture & Recreation SUMMER CAMP REGISTRATION One Form per Participant ---PAGE BREAK--- Shirt Sizes Available: YS, YM, YL, AS, AM, AL, AXL X Parent/Child Playgroup ages 9 months - 4 years 6186 Tiny Tots June 27-Aug. 10 Tue & Thu NA $50 X Mini Camps ages 4-6 years Shirt Size 6229 Aloha Friends June 26, 28, 30 NA $49 6230 Fabulously Funny Fairytales July 10, 12, 14 NA $49 6232 Undersea Explorers July 17, 19, 21 NA $49 6231 Mini Ultimate Sports July 24, 26, 28 $59 6233 Space Spectacular July 31, Aug 2, 4 NA $49 6234 Superhero Squad Aug 7, 9, 11 NA $49 X Summer Day Camp ages 7-12 years 6570 Mission Impossible June 26-30 NA $109 6571 Camp Americana July 5-7 NA $69 6572 War of the Words July 10-14 NA $109 6573 Princesses, Pirates, Ninjas & More July 17-21 NA $109 6574 Space Station Exploration July 24-28 NA $109 6575 Waterpalooza July 31-Aug 4 NA $109 6576 Movie Mania Aug 7-11 NA $109 X Ultimate Sports Camps Shirt Size 6388 Volleyball Camp ages 8-14 June 26-29 $95 6389 Track & Field Camp ages 7-14 July 10-13 $95 6390 Basketball Camp ages 7-14 July 17-20 $95 X Kung Fu Camps Age Many Kung Fu Full Day Weekly June 20-Sept. 1 6-13 $149 Many Kung Fu Half Day Weekly June 20-Sept. 1 6-13 $89 X Specialty Camps Age 6189 LEGO Superheroes June 26-30 6-12 $159 6190 LEGO Movie Making June 26-30 6-12 $219 6534 Little Coders July 10-14 5-7 $239 6535 Video Game Developer Beginner July 10-14 8-14 $239 6536 Video Game Developer Int/Adv July 10-14 8-16 $239 6162 Babysitting Basics July 17-21 10-14 $50 6565 F.I.T. Games July 17-21 8-12 $89 6538 Video Game Dev. Python July 31-Aug 4 10-16 $239 6539 Web Development July 31-Aug 4 10-16 $239 6226 Summer Tunes Concert Band July 24-28 11-15 $69 6227 Summer Tunes Jazz Band Camp July 24-28 11-15 $69 6493 Camp Stitch-A-Lot Crochet July 24-28 8-17 $50 6490 Camp Stitch-A-Lot Sewing 100 July 24-28 8-17 $50 6491 Camp Stitch-A-Lot Sewing 101 July 24-28 8-17 $50 X Dance Camps with Ms Mo Age 6368 Princess Tea Party June 27-29 3-4 $32 6369 Princess Tea Party June 27-29 5-7 $32 6370 Hawaiian Princesses July 11-20, 2wks-T, W, Th 3-4 $64 6371 Hawaiian Princesses July 11-20, 2wks-T, W, Th 5-7 $64 6373 Tapping Trolls July 25-27 3-4 $32 6372 Tapping Trolls July 25-27 5-7 $32 6374 Dancing with my Doll Aug 8-17 2wks-T, W, Th 3-4 $64 6375 Dancing with my Doll Aug. 8-17, 2wks-T, W, Th 5-7 $64 6418 Fluttering Fairies Aug 22-24 3-4 $32 6419 Fluttering Fairies Aug 22-24 5-7 $32 6515 Natural Explorers Aug 7-11 7-12 $120 6516 Edible Education Camp Aug 7-11 7-12 $120 Marysville Parks, Culture & Recreation SUMMER CAMP REGISTRATION One Form per Participant 6915 Armar Rd., Marysville, WA 98270 - Phone [PHONE REDACTED] - Fax [PHONE REDACTED] - marysvillewa.gov