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Summer Camp Application

  1. Gender

  2. Does your child have permission to view G and PG movies *

  3. I wish to enroll my child in: Session 1 Summer Fun May 31 - June 28 (Ages 5 - 12)

  4. I wish to enroll my child in Session 1 Summer Fun May 31 - June 28 (Ages 13 - 16)

  5. The daily times I will need are *

  6. The following activities will be offered from 2:00 to 4:00 pm. Please check only one box per day. Summer Fun Only.

  7. MONDAY *

  8. TUESDAY*

  9. THURSDAY *

  10. I do hereby agree to allow my child to participate in the above name activities sponsored by the Cocoa Beach Parks and Recreation Department. I will assume all risks and hazards incidental to the conduct of the program. In case of injury, I will release, absolve, indemnify and hold harmless the City of Cocoa Beach, its governmental agencies, the organizers, sponsors, transportation connected with the program, any and all of them.

  11. Leave This Blank: