Summer Camp May 30th - June 2nd

Parent/Guardian Information

• * First Name:
• * Last Name:
• * Email Address:
• * Confirm Email Address:
• * Address 1:
• * City:
• * State: --Choose-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -------------- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
• * ZIP Code:
• * Cell Phone:
• * EMERGENCY CONTACTS (Name, Phone, Relationship to child)
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• * PERSONS WHO CAN EITHER PICK UP AND/OR ASSUME RESPONSIBILITY OF A CHILD (Name and Phone)
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• *

  Will your child be needing before and/or after care? ($15 per hour charged daily upon pick up)

  • Yes, Before Only (8am - 9am)
  • Yes, After Only (3pm - 5pm)
  • Yes, Before & After
  • None

• Fee

  Type	Fee
  Camp fee	$360.00

Child Information

• * Child's Name (First and Last)
• * Child's Age (Must be at least 8 years of age)
• * Child's Height (Must be at least 50" tall to race)
• Child's Address (If different from Parent info)
• *

  Does your child have any health concerns (medications, chronic conditions, behavioral or mental disabilities) that we should know about in order to facilitate safe and successful participation?

  • Yes
  • No
• If Yes, Please Describe (Known Allergies and Reactions, Medications and Frequency of Use):
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• * Physician (Name and Phone):
• Please provide any additional information regarding your child that may be helpful:
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• *

  Has your child raced at Victory Raceway before?

  • Yes
  • No
• *

  Has your child attended our summer camps before?

  • Yes
  • No

Lunch Selections for the Week

• * Tuesday: Hot Dogs --Choose-- Hot Dogs Bringing Own Lunch
• * Wednesday: Sandwiches (please note PB&J will not be available if we have any campers who sign up with peanut allergies!) --Choose-- Turkey & Cheese Ham & Cheese Uncrustables Peanut Butter & Grape Jelly Bringing Own Lunch
• * Thursday: Lunchables --Choose-- Build Your own Pepperoni Pizzas Build Your own Cheese Pizzas Ham & Cheddar Cracker Stackers Turkey & American Cracker Stackers Bringing Own Lunch
• * Friday: Pizza Hut Pizza --Choose-- Cheese Pepperoni Sausage Bringing Own Lunch
• Any other food concerns (or allergies)? Vegetarian? Gluten free? If so, please list below and we can make accomodations if possible. (For example, if a gluten allergy we can order a gluten free pizza on pizza days)
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• Each camper will receive 1 - 12oz Gatorade, Apple Juice, or water with lunch. Water will be available at all times to campers. Each camper will get 2 snacks/side with their lunches plus 1 afternoon snack. Snack options include: carrots with ranch, apple sauce, animal crackers, potato chips, oranges, red apples, pretzels, cheese sticks, fruit snacks, & Cheez-Its. All sides (where applicable) will be pre-bagged along with provided ketchup/mustard/mayo/ranch packets.

Sibling Information

You may add a maximum of 3