Winter Camp Vertical

January 11, 2025

Register Today!

Elmbrook Church Brookfield Campus
777 S Barker Rd
Brookfield, WI 53045

Registration Options

Camper ($30.00*)+ Fees and Processing
Payment is required to register. Sales are final and non-refundable

Camper Name

Date of Birth

Gender

Male
Female

Grade of your child at the time of camp.

Has this child attended SUMMER Camp Vertical?

Do you permit Camp Vertical to administer a pain reliever aid: Tylenol or ibuprofen if we see fit for a situation?

Please list any allergies or medical issues for this child:

Has your child been diagnosed or treated for attention deficit disorder (ADD), Attention Deticit / hyperactivity disorder (AD/HD) or any other behavioral disorder that may affect his or her ability to remain focused and attentive during the day? If yes, please add a few specific notes on how we can best support them if you are able.

Medical Information

Medical/Health Insurance Company

Group /Policy Number

Emergency Contact

Emergency Contact Number

Parent/Guardian Name

Mobile Phone Number

Address

Total

$32.39

Includes $2.39 of processing & fees

Your current total for 1 Camper is $32.39

Registration Summary:	Total
Campers (x1)	$30.00
Processing & Fees Fees include credit card processing fees and third-party software fees	$2.39
Total	$32.39

BILLING INFORMATION

Name

Credit Card

Visa
Mastercard
American Express
Discover

Address

Mobile Phone Number

Event Registration Software by RegFox

Winter Camp Vertical

Register Today!

CAMPER REGISTRATION

Medical Information

PARENT / GUARDIAN INFORMATION

BILLING INFORMATION