CIT Registration - Belleville Sportsplex

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618-277-7111

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HY-Viz Marketing
Perfectly Plated
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- Happy Feet 2-5yr
- Happy Feet ISL
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- Volleyball League & Camp Info

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Home
Day Camp
Soccer
- Happy Feet 2-5yr
- Happy Feet ISL
Metro Cup
Basketball
- Basketball League & Camp Info
Volleyball
- Volleyball League & Camp Info

Register as a Camp Counselor In Training

Web Site

Your Name *

Address *

City *

State *

Zip Code *

Your Phone *

Your Cell Phone *

Your Email *

Child Name *

Child Birthdate *

Child Gender *

Child School *

Dr. Name *

Dr. Phone *

Emergency Contact 1 Name *

Emergency Contact 1 Phone *

Emergency Contact 2 Name *

Emergency Contact 2 Phone *

Other Parent Name *

Other Parent Phone *

Any Allergies or Medications *

Pickup Name 1 *

Pickup Phone # *

Pickup Name 2 *

Pickup Name 3 *

List dates you are available *

June 7, 2021 - June 11, 2021

June 14, 2021 - June 18, 2021

June 21, 2021 - June 25, 2021

June 28, 2021 - July 2, 2021

July 5, 2021 - July 9, 2021

July 12, 2021 - July 16, 2021

July 19, 2021 - July 23, 2021

July 26, 2021 - July 30, 2021

August 2, 2021 - August 6, 2021

List any dates you aren't available *

Anything else we naeed to know? *

I have read and agree

to the

Waiver *

How were you referred? *

618-277-7111
2346 Mascoutah Ave. Belleville, IL 62220

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Contact

juergen@bellevillesportsplex.com

General Inquiries

info@bellevillesportsplex.com

Summer Daycamp

bdietrich@bellevillesportsplex.com

World Class Gymnastics
HY-Viz Marketing
Perfectly Plated
Salon Essence
Advertise
Waiver
Job Application

Menu

World Class Gymnastics
HY-Viz Marketing
Perfectly Plated
Salon Essence
Advertise
Waiver
Job Application

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