Jekyll Island 4H Center High School Community Service Event

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Please fill out the form with your information so you are included in our totals for the event. The event will occur July 27th-29th. Fee structures have been emailed to families. Please email tprice@georgiacyber.org with questions. The deadline to fill out this form is June 30th. The deadline to pay fees is July 15th. This event is for GCA High School Students only.

Please enter your last name only(learning coach). *

Please enter your first name only (learning coach). *

Please enter your email address. Please type it out in its entirety. Note all information on this event will be sent to this address. Please email tprice@georgiacyber.org with any questions or to cancel registration. Remember there are no refunds. *

Please enter your telephone number. Please list the best number to reach you at the event and before the outing. *

Please enter the student's cell phone number. This helps when sending updates during the event. This is not required.

Please select the total amount of students attending the programming at the 4H Center on Jekyll Island. Remember this is for GCAHS students only. *

Required

Will you be staying at the 4H Center? *

Yes

If you are staying at the 4H Center please note the total in your party.

Please note the grades of your student(s). *

rising 9th grader/9th

10th grade

11th grade

12th grade

Please note the city in which you reside. *

Please note the names of the GCA students attending. *

Please note their student id. *

Please note any special notes we should know about your family.

Please note here that you understand there are no refunds for this event. *

I understand and have read there are no refunds for this event

Required

Please note here that you understand that if you attend the event as a chaperone you must pay the full programming fee. Chaperones have already been set for the day, if you feel you must attend you must pay the programming fee. *

I understand and have read the information above.

Required

Please note here that you understand that if your student stays in the dorm they must have an adult chaperone with them. *

I understand my student must have an adult chaperone in the dorm overnight.

Required

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