BUSHIKAN WINTER BREAK CAMP

January 5 ~ 9, 2026

Parent Name

Parent Last Name

Address

City

State *

Zip Code

Cell Phone #

Work Phone #

Emergency Contact

Emergency Phone #

Winter break camp fees

Fees are not refundable*

Discount for Siblings – Until June 1, 2026

1st Child $249 * 2nd Child $224 * 3rd Child $199

Number of child

Child Name

Age

School *

Camp Fees 1

Illness/Injuries?

Total: $0.00

CLICK ON REGISTER NOW TO MAKE SECURE PAYMENT