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2021 Youth Summer Camp Registration
Session 2 August 9th-13th, 9am-1pm
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* Indicates required question
Student's Full Name
*
Your answer
Student's DOB
*
MM
/
DD
/
YYYY
Parent/Guardian's Name
*
Your answer
Email Address
*
Your answer
Address
*
Your answer
Primary Phone Number
*
Your answer
Parent/Guardian's Work or Secondary Phone
Your answer
Emergency Contact & Phone Number (other than parent/guardian)
*
Your answer
Who else is authorized to pick up student? (Please provide full name)
Your answer
Are you registering another child?
Yes
No
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