Late Application 2022
Deadline to complete this form Friday, February 25th , 2022.
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Email *
Please select your 1st and/or 2nd camp choices below:  Which week(s) would you like to attend? *
Required
If you have selected to attend both camps, which camp would be your first choice?
Clear selection
Did you attend camp last year (2021)? If so, which one(s)?
If you live in Ninilchik, Homer, Cooper Landing, Moose Pass or Seward, do you need transportation?
Clear selection
Additional Comments:
Student Information Section:
Name of school student attends. (We will be using the students district email for student contact) *
Student Last Name *
Student First Name *
Student date of birth *
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Student age *
Student current grade level *
Student gender *
T-Shirt size *
Does the student have a one-on-one aide, shadow, or interpreter?
Clear selection
What math class is the student currently taking? *
I understand the student paragraph MUST be submitted by Friday, February 25th , 2022 in order for this application to be completed.  It can be bizhubbed from your school office or emailed to nkant@kpbsd.k12.ak.us. Maybe take a picture of the directions above so you have the information needed to write on. *
Parent /Guardian information
Parent/Guardian first and last name *
Parent/Guardian physical address: *
Parent cell phone, home phone, work phone *
Parent/guardian email address if different than the one provided above. Our main method of communication is email due to the high number of applicants.  Please enter a parent/guardian email address that will be checked regularly.  In addition, we will use the student's KPBSD Gmail account when contacting students.  
AUTHORIZATION OF RECORDS RELEASE - FOR PARENT/GUARDIAN TO COMPLETE!
I authorize a representative of KPBSD Summer Camp to access KPBSD transcripts for my student.  This data may include, but is not limited to attendance and current grades.  I understand this data will be used solely for the purposes of determining the success of this camp.  Information will not be shared with any other individuals or agencies without written permission of the parent/guardian. *
I hereby consent of the release of the information to KPBSD Summer STEAM Camp.  (Please type parent full name below.) *
Date completed: *
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Next Steps....
A copy of your responses will be emailed to the address you provided.
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