Creator's Lab Registration Form
                                                                            REGISTRATION FORM 

NOTE: Note this program is reserved for 10 years and up ONLY 
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Parent/Guardian Email *
Parent/Guardian Phone *
Parent/Guardian Name | Relationship to Child
 *
Parent/Guardian Name | Relationship to Child
Child's Full Name (First, Last)
 *
Child's Date of Birth
 *
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DD
/
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Child's Age *
Child's Gender
 *
Child's Address, City/ Town, State, & Zip Code
Child's School (Town, State, Zip Code)
 *
Child's Grade
(Spaces available for only 10 years old and up)
 *
Emergency Contact Name
 *
Emergency Contact Relationship to Child
 *
Emergency Contact Phone (Cell)
 *
Emergency Contact Phone (Alternative)
Dismissal: Will your child...
 *
Pick-Up #1 Full Name | Relationship to child 
 *
Pick-Up #1 Phone Number
 *
Pick-Up #2 Full Name | Relationship to Child 
Pick-Up #2 Phone Number
Are there any custody arrangements of which we should be aware?
Child T-Shirt Size
 *
Are there any modifications your child needs due to physical disabilities, allergies, etc.?
 *
Registration Fee

Inspire Life's goal is to make this camp affordable for all families. The full cost per child is $150 for 6 weeks. At minimum we charge the fee below. However, if you are able to pay more we welcome the donation to help others attend. Fee may be paid by any of the ways listed below. 
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How will you pay?  *
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