School Fall Break – Camp ONLINE Registration

 

You are encouraged to complete the below online registration form to ensure the fastest processing of your application.

If you prefer, you may click here to open a blank PDF School Fall Break Camp Registration form (opens in a new browser tab), fill it out, and mail it to the ACRA office address as indicated at the bottom of the form.

School Fall Break Camp Registration Form

School Fall Break Camp Registration Form

Student Information

Student’s Name
Student's Name
First
Last
School Attending
Current Grade
Do you receive a prequalified TRC Subsidy?

TRC subsidy payments are accepted. If your family has a TRC Subsidy and also participates in the ACRA KAP Program, your enrollment fees will automatically be covered. Important: You still need to complete the Registration Form online to reserve your spot.

If you have been approved for a TRC Subsidy but do NOT participate in the ACRA KAP program, please contact your TRC case worker before camp starts, and ask to issue a Temporary Change of Provider Certificate with ACRA as a “Provider”. Important: Complete your Registration Form online to reserve your spot in the program.

Choose Your Enrollment Option:

Important: Your student’s space in the Fall Break Camp is not reserved until the payment has been received.  You will be prompted to pay today when you press the SUBMIT button at the end of this form. If you cannot pay today with your submission, you can return to this website and locate the Fall Break Camp Payment link under the Youth Services menu.  Payment is due by October 11th.

Price shown is for the full week of camp.
Price shown is for the full week of camp.

NOTE: A $25 late fee will be charged for each day that your student is not picked up within 15 minutes of the purchased plan end time:
Regular day late fee begins at 4:15
Extended day late fee begins at 5:45

Parent or Guardian information

Name
Name
First
Last
Would you like to add a second Parent’s or Guardian’s Information?

Additional Parent or Guardian Information

Name
Name
First
Last
Address
Address
City
State/Province
Zip/Postal

Who is allowed to pick up your child from KAP other than the parents or guardians listed above (must be 18 or older)

Name
Name
First
Last
Name
Name
First
Last
Name
Name
First
Last

Is there anyone excluded from picking up your child?

Exclude Persons from Pickup?

Indicate person(s) excluded from picking up your child from KAP

Name
Name
First
Last
Add another excluded person?

List the additional person excluded from picking up your child.

Name
Name
First
Last
Start Over