Destination Imagination Summer Camp 2019 Scholarship Application

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Student First Name: *

Student Last Name: *

Current Campus: *

Current Grade Level: *

Homeroom Teacher: *

Parent Name: *

Best Phone Number: *

Mailing address: *

Parent E-mail Address: *

HEALTH CARE NOT AVAILABLE By typing your name below you are indicating that you are aware that there is no nurse or health care assistant available during Destination Imagination Summer Camp. Medication will not be administered to your child while he/she is attending this camp. Emergency response (911) will be called if there is a medical emergency. The parent/guardian will be responsible for all expenses related to emergency medical care. *

Does your child have any allergies or other health conditions that the Destination Imagination Summer Camp Staff needs to be aware of? *

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