Little Olympians Program Registration Form

Camper's first name

Last name

Date of birth
Male Female

2nd camper's first name

Last name

Date of birth
Male Female

3rd camper's first name

Last name

Date of birth
Male Female

Parent's name (required)

Street address

City

State

Zip code

Parent's email (required)

Primary phone (required)

Work phone

Other phone

Emergency contact

Relationship

Phone

Child's primary care physician

Physician's phone number

I authorize the following people to pick up my child/children:

Name Relationship Phone

Name Relationship Phone

Name Relationship Phone

Little Olympians Program Sessions

Note: Before signing up, see the Little Olympians Program page for availability.

Please check desired sessions

Session 1 July 9 - 13	Session 2 July 16 - 20	Session 3 July 23 - 27
Session 4 July 30 - August 3	Session 5 August 6 - 9

Please check needed extended hours ($50 per week)
8:30 - 9:00 am ($10 per week)
3:30 - 5:30 pm ($40 per week)

Required Forms

Download this NYC Health Department medical form. Have it completed by your child's physician and send it to Camp Olympia by May 25, 2012.
Please also download the camp agreement, sign it and return it as soon as possible.

Children will not be allowed to attend Camp without a completed and signed medical form or camp agreement.

Little Olympians Program Fees
Each one-week session is $185.

To secure your spot at camp, a $50 deposit is to be paid for each week your camper is registered. This deposit should be submitted with completed application. Deposit is refundable until May 1, 2011. In an effort to minimize registration expenses, parents are responsible for calculating the fees paid to Camp Olympia.

No refund after May 1, 2012.

Balance due May 25, 2012.

Make check payable to

Camp Olympia
7304 5th Ave, # 271
Brooklyn, NY 11209

For your records. . .