Summer Camp Enrollment Form

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Christine Elizabeth Academy

Camper's Name *

Which CEA Summer Camp would you like to attend? *

Summer Bridge:The Summer Bridge Program is designed to address learning gaps in students by offering targeted educational interventions during the summer break. This program aims to provide additional support and resources to help students bridge any academic deficiencies, ensuring a smoother transition to the upcoming school year.

CEA Camp: Regular Day Camp

Grade Level (rising grade) *

Rising 1st

Rising 2nd

Rising 3rd

Rising 4th

Rising 5th

What school does Camper attend? *

Camper's Address (please include city and zip code) *

Camper's Date of Birth *

YYYY

Camper's Age *

Camper's Gender *

Female

Male

Other:

Camper's T-Shirt Size *

Other:

Does Camper have ANY Food Allergies? *

Guardian 1 Full Name *

Guardian 1 Contact Phone Number *

Guardian 1 Email *

Guardian 2 Full Name *

Guardian 2 Contact Number *

Guardian 2 Email *

Emergency Contact Name and Number *

SELECT YOUR WEEKS *

MAY 28th

JUNE 3rd

JUNE 10th

JUNE 17th

JUNE 24th

JULY 1st

JULY 8th

JULY 15th

JULY 22nd

UNSURE YET

Required

By submitting this form you verify that the enrollment form is accurate and complete and you release Christine Elizabeth Academy and individuals from liability in case of accident during activities related to Christine Elizabeth Academy as long as normal procedures have been followed. *

This serves as my Electronic Signature

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