Online Registration

2018 imagine That! Registration Form

New Location!
The Village School
3411 Willamette Street
Eugene, OR

Please be advised that July 4 will be a regular camp day.

To Register for imagine That! please fill out the registration form below. Items marked with * are required.


Camp Information

Please select the camp you want to register for using the options below.
At checkout you will be provided the option to pay with a $40 deposit or the full amount.
  *Camp Date  
  *Camp Hours  


Student Information

  *Student's Name  
  *City       *Zip  


Parent/Guardian Information

  *Home Phone  
  Work Phone  
  *Emergency Contact Name  
  *Emergency Contact Phone  
  Paypal Email   Only if different than parent email
Second Parent/Guardian (optional)
  Full Name  
Additional Contacts (optional)
Others who are authorized to pick up your child from camp.
  Any Other Parent Info We Should Know


Medical Information and Authorization

  Allergies/medical conditions important for us to be aware of:
*Is your child currently receiving medication? No Yes
I give permission to the summer camp staff to assist my child with prescribed medication? (if applicable)
Emergency Medical Treatment Authorization:
As a parent or legal guardian of the above-mentioned child, by submitting this camp registration form, I hereby authorize “Imagine That!” staff to call an ambulance or take my child to any available physician or hospital at my expense if a parent or legal guardian cannot be reasonably located when the child is brought for treatment. This authorization will expire on the completion of the assigned camp.

*Parent or legal guardian name: