Orientation Registration Form
Fill out this form to officially enroll in the Teen Biz Camp!
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Email *
Teen's First Name: *
Teen's Last Name: *
Name of School *
Grade Level *
Age: *
Birthday: *
MM
/
DD
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Parent/Guardians Name: *
Street Address: *
City *
State *
Zip Code *
Tel. No.: *
Mobile No.: *
Does your teen have any learning disabilities or will they need extra tutoring? *
Emergency Contact Name: *
Emergency Contact Relation: *
Emergency Contact No.: *
Does your child suffer from any allergies, illness, disability or other medical conditions? If yes, please detail below: *
What allergies or medical conditions does your teen have?
Do you have a preferred hospital you would like your child to be transported to? If yes, please detail below: *
Name of Hospital or Primary Doctor and Phone Number
Will you need financial assistance for the tuition fee? If so, please check the reason below.
Clear selection
If you selected "other" on the question above, please identify the reason for financial assistance.
Which camp location will your teen attend? *
Which Teen Biz Box would your kid like? *
How did you hear about Teen Biz Camp?  *
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