Health Careers Camp Registration
Health Careers Camp is a 3 day summer career intro camp for any students entering grades 7-9th who are interested in a future in Health Occupation, and are looking for exposure into the health/medical field. This camp will give insight and real life experience into multiple careers in the medical field. This camp will include job shadows and tours of medical facilities’ as well as hands on experience!
Email address *
$45 per camper
In addition to this registration we will need a permission slip and photo release form printed out and signed then mailed back to LESA. There is a link underneath this one on the students page of the lcaan website.
Please make checks payable to LESA and mail to address below in order to confirm registration spot.
LESA Building
1425 W Grand River Ave.
Howell, MI 48843
Camper's First Name
Your answer
Camper's Last Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Street Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Country
Camper's grade for next fall
Camper's school name
Your answer
School's City
Your answer
School District
Your answer
Emergency Contact #1 Name
Your answer
Contact Number
Your answer
Relation to Camper
Your answer
Emergency Contact #2 Name
Your answer
Contact Number
Your answer
Relation
Your answer
List Camper's conditions/restrictions. i.e. allergies, asthma, diabetes, etc.*
Your answer
Insurance Company
Your answer
Name on card
Your answer
Group # and/or Policy #
Your answer
Camper's T-shirt size? (Sizes are guaranteed with registration by 6/8/17)
Submit
Never submit passwords through Google Forms.
This form was created inside of Livingston Educational Service Agency. Report Abuse - Terms of Service - Additional Terms