Child Activity Registration Form

Bruin X-Treme Summer Day Camp 2026

Please fill out your child's details and select the activities you wish to enroll in.
Name

First NameLast Name
Email
example@example.com
Emergency Contact
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Early Morning Care 7:00 am - 8:45 a.m.

$25.00

Bruin X-Treme Day Camp 8:45 a.m. - 12:00 p.m.

$190.00

Afternoon Care 12:00 p.m. - 3:30 p.m.

$175.00

Camp + Extended Care 8:45 a.m. - 3:30 p.m.

$360.00

Extended Care 3:30 p.m. - 5:30 p.m.

$30.00

Daily Lunchbox & Snacks Entire Week

$65.00

Total

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Bruin X-Treme Summer Day Camp 2026