The 2019 Middle School Chicago Debate Summer Institute
July 22nd – August 2nd, M-F 9 am – 3:30 pm
Dunbar Career Academy, 3000 S. King Dr.

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CONTACT INFORMATION:
Please fill as completely as possible so that we may contact you with any problems or issues affecting your student.
Student's First and Last Name: *
Nickname or other preferred name (skip if none):
Student's preferred pronouns: *
Student Email (put N/A if none)                               PLEASE INCLUDE NON-CPS EMAIL: *
Student Cell Number (put N/A if none): *
Mailing Address: *
Parent/Guardian Name: *
Parent/Guardian Cell Number (put N/A if none): *
Parent/Guardian Work Phone Number (N/A if none):
Home Phone Number (N/A if none): *
Parent E-mail (put N/A if none): *
Preferred Method of Contact for Parent/Guardian: *
Student Birthdate: *
Student Age: *
Student Dietary Restrictions: While we want to be aware, please note that these cannot be accommodated other than Vegetarian and possibly Vegan items. Students with severe allergies must plan to bring their own lunch.
2018/2019 School Attended: *
School your student will attend in Fall of 2019: *
Grade Level your student will be in in Fall of 2019: *
Will you be attending the full two weeks? *
(If your student wishes to attend the first week only, they will be added to a waitlist as two week attendees will be given priority. Based in space available, we will admit those on the waitlist in July. One week attendees can defer payment until they are contacted in July confirming admittance.)
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