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2023 Eagles Summer Camp Registration Form
Deadline for Payment May 24th, 2023
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* Indicates required question
Email
*
Your email
Student 1 Name
*
Your answer
Student 1 Date of Birth
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MM
/
DD
/
YYYY
Student 1 Age (in years)
*
3-4
5-6
7-8
9-10
11-12
Student 2 Name (If Applicable)
Your answer
Student 2 Date of Birth
MM
/
DD
/
YYYY
Student 2 Age (in years)
3-4
5-6
7-8
9-10
11-12
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Student 3 Name (If Applicable)
Your answer
Student 3 Date of Birth (If Applicable)
MM
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DD
/
YYYY
Student 3 Age (in years)
3-4
5-6
7-8
9-10
11-12
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Student 4 Name (If Applicable)
Your answer
Student 4 Date of Birth (If Applicable)
MM
/
DD
/
YYYY
Student 4 Age (in years)
3-4
5-6
7-8
9-10
11-12
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Home Address
*
Your answer
Mother's Name
*
Your answer
Mother's Cell #
*
Your answer
Mother's Email address
*
Your answer
Father's Name
*
Your answer
Father's Cell #
*
Your answer
Father's Email address
*
Your answer
Would you be okay if we served your child(ren) pizza on Fridays?
*
Yes
No
Any allergies (List students name with any allergies)
Your answer
Authorized People to pickup(other then parents listed above)
Your answer
I give permission for my child to be photographed or videotaped?.
*
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No
Submitters Name (Signature)
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Your answer
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