Participant Information Form

Please fill out this form with participant information

We will match this information with your payment information. Summer camp and PD Day Registration is not complete until payment is complete.When payment is received a receipt will be automatically generated and sent to the email address provided. Payment Options are located above this form for Summer Camp and PD Days.

*If you are filling out this form regarding an After School Program inquiry we will reach out upon receiving the form.

Child’s Full Name *

Email *

Medical Conditions/Allergies *

Child’s Age *

Additional Information

Parent Contact Name *

Social Media Consent *

Would you be comfortable with your child being included on Active Islanders Social Media?

Phone *

Grade Level Entering 2025/2026 School Year

If the product you have selected is "sold out" would you like to be added to a waitlist?

Thanks for getting in touch!

Registrations will be considered complete when the payment process is completed(payment options located above this form)

Please ensure the event you’re interested in is available for purchase and not “Sold Out”. If the event is sold out, you may inquire within to be added to a waitlist. If you would like to make alternative payment arrangements(Example: Etransfer or Cash Payment) please reach out to us at activeislanderspei@gmail.com or (902) 830-7159

Have a great day!

Thanks for getting in touch!

Registrations will be considered complete when the payment process is completed(payment options located above this form)

Have a great day!

Branding Fee April 20 2025