Summer of STRYV: Empower, Engage, Excel!

Please fill out a different registration form for each child you are signing up.

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* 1. We require one of the following for each camp participant:

Copy of birth certificate

Copy of state ID card

Copy of a student report card

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* 2. Parent/Guardian Full Name

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* 3. Parent/Guardian Email Address

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* 4. Parent/Guardian Telephone Number

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* 5. Parent/Guardian Home Address

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* 6. Child's Full Name

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* 7. Child's Age Group

9-12 years old

13-17 years old

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* 8. Child's Date of Birth

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* 9. Emergency Contact Number

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* 10. Alternate Emergency Contact Number

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* 11. Any medical conditions or allergies we should be aware of?

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* 12. Does your child require any special accommodations?

Yes

No

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* 13. If you answered 'Yes' to the previous question, please specify the accommodations needed.

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* 14. Besides the parent/guardian listed above, please list alternate individuals allowed to pick-up your child

Full Name - Alternate Pick-up Person # 1

Full Name - Alternate Pick-up Person # 2