summer camp
Summer Camp Form
Fill out this form to register your child for Dizzy's Amazing Race Summer Camp
Camper's Name
*
First
Last
Camper's Age
Gender
Male
Female
Birthday
Parent/Guardian Name(s)
Phone
###
-
###
-
####
Address
Street Address
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
?Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country
Email
*
Special Notes About Camper
Second Camper
If you would like to register a second camper please fill out the following section if they are to be registered for the same days as the first camper, if you would like them registered for different days please fill out a new form.
Second Camper's Name
First
Last
Second Camper's Age
Second Camper's Gender
Male
Female
Second Camper's Birthday
Camp Days
Select Camp Days and Times
Week 1: Camping in Canada
(6/18 - 6/22)
Mon
Tues
Wed
Thurs
Fri
Week 1:
Regular Day
Extended Day
Week 2: Under the Sea in Australia (6/25-6/29)
Mon
Tues
Wed
Thurs
Fri
Week 2:
Regular Day
Extended Day
Week 3: Fiesta in Mexico (7/2 – 7/6, no camp on Wednesday, 7/4)
Mon
Tues
Thurs
Fri
Week 3:
Regular Day
Extended Day
Week 4: Tropical Rainforest in the Amazon Jungle (7/9 - 7/13)
Mon
Tues
Wed
Thurs
Fri
Week 4:
Regular Day
Extended Day
Week 5: Royalty of Great Britain (7/16 - 7/20)
Mon
Tues
Wed
Thurs
Fri
Week 5:
Regular Day
Extended Day
Week 6: Fossil Dig in the Sahara (7/23 - 7/27)
Mon
Tues
Wed
Thurs
Fri
Week 6:
Regular Day
Extended Day
Week 7: Beach Party in Thailand (7/30 - 8/3)
Mon
Tues
Wed
Thurs
Fri
Week 7:
Regular Day
Extended Day
Week 8: Wild West in Texas
(8/6 - 8/10)
Mon
Tues
Wed
Thurs
Fri
Week 8:
Regular Day
Extended Day
Week 9: Pirates & Mermaids of the Pacific Ocean (8/13 - 8/17)
Mon
Tues
Wed
Thurs
Fri
Week 9:
Regular Day
Extended Day
Week 10: Back home to Dizzy's Big Top Circus (8/20 - 8/24)
Mon
Tues
Wed
Thurs
Fri
Week 10:
Regular Day
Extended Day
Week 11: Mystery Week
(8/27 - 8/31)
Mon
Tues
Wed
Thurs
Fri
Week 11:
Regular Day
Extended Day
Single Line Text
Payment Options
We require a 50% of the camp total and the remainder will be due on the first day of camp each week.
Card Type
Visa
Mastercard
Name on Card
Card Number
Expiration Date
Billing Zip Code
Paypal
Yes, I'd rather use PayPal
Check here if you'd rather be billed through PayPal (will be sent through email)
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