CAMP CKC 2023 Application

Please complete this form to register your camper for CAMP CKC 2023.

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 call our Box Office at (773) 205-9600 or reach out to info@chicagokidscompany.com.

Application date: *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

Name of Camper *

First

Last

Age *

Camper's pronouns:

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: *

• Chicken Little - June 10-14, 2024 Ages 5-9
• The Little Mermaid - June 17-21, 2024 Ages 5-9
• Pinocchio - July 8-12, 2024 Ages 5-9
• Goldilocks and the Three Bears - July 22-26, 2024 Ages 5-9
• Peter Pan - August 5-9, 2024 Ages 5-9
• Disney's Finding Nemo KIDS - June 24-28, 2024 Ages 9-12

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, or would like to discuss a payment plan, please reach out to russ@chicagokidscompany.com or call (773) 205-9600. Refund policy: We will refund you in full up to two weeks before the first date of the session. After that date, there is no refund.

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