Registration

Camp Nexplore Registration

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Coupon

Camper Information

First Name *

Last Name*

Grade *

Parent Information

First Name*

Last Name*

Address 1*

Address 2

City*

State/Province*

Zip/Postal Code*

Primary Phone Number*

Secondary Phone Number*

Email Address*

Who is authorized to pick up the child. List all adult names. (First and Last)

Other Authorized Guardian

First Name

Last Name

Relationship

Phone

Emergency Contact

Same as parent information

First Name*

Last Name*

Phone*

Relationship

Medical Information

Allergies (Food, Medication, Environmental)

Dietary Restrictions (Vegetarian, Gluten-Free, etc.)

Medical Conditions (Asthma, Diabetes, etc.)

Payment Information

Same as parent information

First Name*

Last Name*

Address 1*

Address 2

City*

State/Province*

Zip/Postal Code*

Card Information

Card Number*

Expiration Date*

CCV*

Important Stuff

I have read and agree to the Policies.
I have read and agree to the Waiver and Release.

Please do not close your browser or click the back button.

Registering more than one child? To avoid an error message, please either use a different credit card for the second transaction or wait one day to use the same credit card. Our system uses a safety precaution to avoid duplicate charges.