2025 Summer Camp Registration Form

Question Title

* 1. Student's Full Name

First name

Last name

Question Title

* 2. Student's DOB

DATE

Date

Question Title

* 3. Student's Gender

Male

Female

Other (please specify)

Question Title

* 4. Student's Preschool or Elementry School

Question Title

* 5. Parent/Guardian's Full Name

First name

Last name

Question Title

* 6. Parent/Guardian's Email Address

Email address

Question Title

* 7. Parent/Guardian's Phone Number

Country Code

Phone number

Ext.

Question Title

* 8. Home Address

Street address

City

State

Country

Question Title

* 9. Estimated weeks of attendance (you may modify this at any time before 5/1/2025)

Week 1 6/2

Week 2 6/9

Week 5 6/30

Week 8 7/21

Week 9 7/28

Week 10 8/4

Question Title

* 10. Are there any medical conditions or allergies we should be aware of?

Yes

No

Question Title

* 11. If yes, please provide details about medical conditions or allergies

Question Title

* 12. Emergency Contact Name

Question Title

* 13. Emergency Contact Phone Number

Country Code

Phone number

Ext.

Question Title

* 14. How did you hear about our summer camp?

Social Media

Friends/Family

School

Online Search

Other