JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Close Reach Academy Application: School-age Summer Camp
Thank you for your registration! We will be in touch within 48 hours to confirm your enrollment.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Student name
*
Your answer
Student birthday
MM
/
DD
/
YYYY
Please select all of the weeks you would like your child to attend Summer Camp
*
June 17th
June 24th
July 1st (no camp offered July 4th or 5th)
July 8th
July 15th
July 22nd
July 29th
August 5th
August 12th
August 19th
Required
I understand that each week of summer camp is $250 and agree to pay weekly
*
Yes
Required
Parent/Guardian 1
*
Your answer
Email
*
Your answer
Phone
*
Your answer
Address (if different from student)
Your answer
Parent/Guardian 2/Emergency Contact
Your answer
Email
Your answer
Phone
Your answer
Address (if different from student)
Your answer
Does your child have any allergies or health concerns?
Your answer
Please use this space for any additional information
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Close Reach.
Report Abuse
Forms
