Spring Break Camp Registration-Closed at this time... Child's Name First Last Child's Age Child's Date of BirthMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Name of Parent/Guardian First Last Mailing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Primary PhoneOther PhoneLiability Waiver I agree to the liability waiver.I hereby give my permission to allow my child named above to participate in the activities offered by Blue Lake Break Camp. I understand that this waiver of liability protects the City, Parks & Recreation Department, and all employees from any and all injuries, physical and mental, that occur and/or are alleged to occur to my child named above during activities my child undertakes on his/her own or participates in while attending the Blue Lake Break Camp, including those offered during extended care hours. I understand that the City be held free and harmless from any and all liability claims, demands, damages, costs, and expenses resulting from participation in the activities at Blue Lake Break Camp.Blue Lake ResidencyAre you a resident of Blue Lake and/or does your child attend Blue Lake School? Yes No Program Information General Information: Blue Lake Break Camp is a fun and exciting youth recreation program for children ages 5-13 taking place at Prasch Hall. Activities focus on arts and crafts, fun games, sports, skating, and more. Program Days/Hours: Blue Lake Spring Break Camp is offered Monday, April 22nd – Friday, April 26th, from 8:00 am- 5:00 pm Program Fees: Blue Lake Break Camp offers different registration options to accommodate today’s busy family schedules. Half day options allow attendance from either 8:00am-12:00pm or 1:00pm-5:00pm. Snacks and Lunches: Campers will bring their own snacks and lunches. *The free breakfast and lunch program only applies to our Summer Camp program. Program RegistrationPre-registration is suggested to ensure a spot.Monday, April 22nd None Half Day - AM Half Day - PM Full Day Tuesday, April 23rd None Half Day - AM Half Day - PM Full Day Wednesday, April 24th None Half Day - AM Half Day - PM Full Day Thursday, April 25th None Half Day - AM Half Day - PM Full Day Friday, April 26th None Half Day - AM Half Day - PM Full Day Total $0.00 Pick Up AuthorizationNameContact Phone # Please list all persons authorized to pick your child up from camp, including yourself.