CAMP CKC 2020 Application

Please complete this form to register your camper for CAMP CKC 2020.

Credit card payment can be made by calling the box office at (773) 205-9600 or mailed in within two weeks of submission to 4124 N. Nashville Ave., Chicago, IL. 60634. Checks should be made payable to “Chicago Kids Company.”

Application date: *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

Name of Camper *

First

Last

Age *

Camper's preferred pronouns (optional):

Name of Guardian *

First

Last

Phone *

Address *

Address Line 1

City

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

Zip Code

Email *

Additional Guardian

First

Last

Phone

CAMP CKC 2020 Sessions *

• July 6-10, 2020 10am-2pm $200 Ages 6-9
• July 13-17, 2020 10am-2pm $200 Ages 6-9
• July 20-31 2020 10am-3pm $500 Weekdays Only Ages 10-17

Emergency Contact *

An adult not previously listed on the application

Emergency Contact Phone *

Emergency contact's relationship to your camper: *

Does your camper have any allergies we should know about?

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

Total

$ 0.00

Credit card payments can be made by calling the CKC box office at (773) 205-9600. We are open Monday-Friday, 9am to 5pm. Checks made payable to CHICAGO KIDS COMPANY may be mailed in within two weeks to 4124 N. Nashville Ave., Chicago, IL. 60634. Please include your campers name in the memo line.

Website

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