CAMP CKC 2021 Application

Please complete this form to register your camper for CAMP CKC 2021.

Upon completion of this form, click submit at the bottom of this page and follow the steps to make a credit card payment. If you have any questions, feel free to reach out to info@chicagokidscompany.com.

Application date: *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

Name of Camper *

First

Last

Age *

Camper's preferred pronouns (optional):

Name(s) of Guardian *

Phone *

Address *

Address Line 1

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Email *

Additional Emergency Contact

Phone

PLEASE SELECT AT LEAST ONE: *

• SOLD OUT - June 28 - July 2, 2021
• SOLD OUT - July 5-9, 2021
• SOLD OUT - July 12-16, 2021
• July 19-30, 2021 Ages 10-17 - $500

Does your camper have any allergies we should know about?

Should we be aware of any medications your camper is taking?

Total

$ 0.00

Upon submission of this form, you will be directed to the payment page. Place the appropriate camp in your "shopping cart" and follow the steps to submit credit card payment. If you would prefer to pay by check, please mail to CHICAGO KIDS COMPANY 4124 N. Nashville Ave., Chicago, IL. 60634. Should you need any assistance, please reach out to info@chicagokidscompany.com.

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