Summer Camp Registration

Summer Camp Registration Form

To book a spot in the camp, please complete the form below accurately.

First Name:

Last Name:

Birthdate:

Phone Number:

Email Address:

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Please provide any medical or dietary restrictions your student has:

Which camp will your student attend?

School Name:

School Address:

Street Address Line 2

City

State / Province

Postal / Zip Code

Grade your student will be entering:

Current GPA:

Parent/Guardian's Name:

Last Name

Contact Phone Number:

E-mail Address:

Emergency Contact Name:

Last Name:

Emergency Contact Phone Number:

Relationship to Student:

Please describe how you feel the camp will benefit your student: