NVA Members - Hip Works

Summer Camp Registration

"*" indicates required fields

Name*

Email*

Phone Number*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How did you hear about us

Please list any Allergies or Medicial Issues we need to be aware of

Emergency Contact Information*

Number of children attending*

Please enter a number from 1 to 20.

Select weeks*

Week 1: 6/20 – 6/24

Week 2: 6/27 – 7/1

Week 3: 7/4 – 7/8

Week 4: 7/11 – 7/15

Week 5: 7/18 – 7/22

Week 6: 7/25 – 7/29

Week 7: 8/1 – 8/5

Week 8: 8/15 – 8/19

Week 9: 8/22 – 8/26

Product MVA Sumer Camp*

Total

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