Summer Day Camp Register For Summer Camp Our Programs Locations Twos Program Primary Program Elementary Program Extended Day Summer Day Camp Bilingual Spanish Bilingual Chinese Spring Break Camp Snow & Emergency Policy Step 1 of 3 33% Child Name(Required) First Last Date of Birth(Required) MM slash DD slash YYYY Gender(Required) Male Female Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent's Names(Required)Parent 1 WorkParent 1 Cell(Required)Parent 1 Email(Required)Parent 2 WorkParent 2 CellParent 2 EmailPrevious school, camp, or daycare experienceAllergies or other significant medical condition(Required)PotomacToddlers (2 years) 9:00 - 12:00/5 days a week 9:00 - 3:00/5 days a week 7:30 - 9:00 before care 3:00 - 6:00 after care* *Includes before care from 7:30-9:00Primary (3-6 years old) 9:00 - 12:00/5 days a week 9:00 - 3:00/5 days a week 7:30 - 9:00 before care 3:00 - 6:00 after care* *Includes before care from 7:30-9:00St. D's/BethesdaToddlers (2 years) 9:00 - 12:00/5 days a week 9:00 - 3:00/5 days a week 3:00 - 6:00 after care Primary (3-6 years old) 9:00 - 12:00/5 days a week 9:00 - 3:00/5 days a week 3:00 - 6:00 after care RockvilleToddlers (2 years) 9:00 - 12:00/5 days a week 9:00 - 3:00/5 days a week 7:30 - 9:00 before care 3:00 - 6:00 after care* *Includes before care from 7:30-9:00Primary (3-6 years old) 9:00 - 12:00/5 days a week 9:00 - 3:00/5 days a week 7:30 - 9:00 before care 3:00 - 6:00 after care* *Includes before care from 7:30-9:00Session Dates2025 Session Dates Week 1: June 9-13 Week 2: June 16-20 (no camp 19th/prorated) Week 3: June 23-27 Week 4: June 30-July 3 (no camp 4th/prorated) Week 5: July 7-11 Week 6: July 14-18 Week 7: July 21-25 Week 8: July 28-August 1 Week 9: August 4-8 2025 Session Dates - Potomac Location Only Week 10: August 11-15 Youth Camp Health HistoryChild's Name(Required) First Last Current Residence(Required) Same as address above Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Emergency Contact InformationEmergency Contact (when parents can't be reached)(Required)Someone other than Parent or Legal Guardian.Phone(Required)2 Emergency ContactPhoneName of Person(s) Authorized to Pick Up Child (daily):Relationship to Child:Phone Number:0 of 100 max charactersPrimary Care Physician or other provider of medical care(Required)Phone(Required)Are there any health problems including physical, psychiatric, or behavioral problems of which we need to be aware?(Required) No Yes ExplainAre there any medications, dietary restrictions, allergies, or special needs that we need to be aware of to ensure that your child's camp experience is positive?(Required) No Yes Name of Person(s) Authorized to Pick Up Child Daily:(Required)0 of 100 max charactersRelationship to Child:0 of 100 max charactersPhone Number:0 of 100 max charactersIMMUNIZATION INFORMATIONMust list current residence aboveFor campers who currently reside within the United States, a United States territory, or the District of Columbia: Does the camper have any immunization exemptions because of a parental or guardian objection or medical contraindication?(Required) No Yes ExplainOutside of US Record of Vaccination or ImmunityFor campers who reside outside the United States, a United States territory, or the District of Columbia: Attach record of vaccination or immunity on Department form MDH-896 *Please note: fI your child has an allergy or takes medication, we will need an allergy action plan and medication authorization form prior to their attendance at camp.*Max. file size: 50 MB.For campers who reside outside the United States, a United States territory, or the District of Columnia: Attach record of vaccincation or immunity on Department form MDH-896. *Please note: if your child has an allergy or takes medication, we will need a allergy action plan and medication authorization form prior to their attendance to camp.* PHOTO RELEASE FORM First By selecting here, I agree to allow my child to be photographed for advertisement purposes or to show the child in a group setting while in care. Pictures are allowed to be published on Manor’s social media platforms and websites. Summer Camp Deposit Price: Total Credit CardCard Details Cardholder Name EmailThis field is for validation purposes and should be left unchanged.
