Student Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent Name *

First Name

Last Name

Parent Phone *

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Select the Camp Anacapa sessions you would like to attend *

Full Program: June 16 - June 27, 2025 ($750)

Session I: June 16 - June 20, 2025 ($350)

Session II: June 23 - June 27, 2025 ($350)

Extended Care:

Early Drop-off / Late Pick-up (8:30 am to 4:30 pm) is available for $175 per session.

Full Program: Early Drop-off / Late Pickup - $350 extra fee

Session I: Early Drop-off / Late Pickup - $175 extra fee

Session II: Early Drop-off / Late Pickup - $175 extra fee

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

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