APM Summer Camp Registration Form
Helping Students Achieve Their Dreams (July and August)
Choose A Location *
Legal First Name and Last Name: *
Camper only
Preferred Name:
Age: *
Participant only
Gender *
Participant only
Current School
Name of participants current school.
Home Phone:
Mobile Phone:
Home Address
Postal Code
Email Address:
Please confirm Email Address. (Confirmation of Registration will be sent to Email Address)
Date of Birth
T-Shirt Size:
Please Choose One.
Clear selection
Please Specify: (If none please specify)
Special Dietary Accommodations:
If none, please specify:
Health Card #:
Does your child acquire extra staff assistance at school?
If Yes? You will be contacted in 24 hours on confirmation of student to staff support. All students benefit when their parents or care givers get involved in supporting their summer education. This is especially important if your child has a disability.
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Pick Up and Drop Off Permission:
Please let us know the first name and last name of individuals given permission to pick up your child from camp or If your child has permission to walk home.
Emergency Contact Name:
Emergency Contact Telephone:
Emergency Contact Relation to the Camper
ex. mother, father, grandmother
Name of Person Registering Child:
Are you this child's parent or guardian?
Clear selection
Telephone Contact
Please Confirm Email Address *
Please Select the Weeks you are interested in: *
2 weeks minimum is required.
Payment Options *
In order to complete registration payments must be completed before June 30th 2019
Payment Methods *
Payments are due by June 30th 2019
Please Request your Payment Plan *
Please Include Comments/Request that you would like us to know?
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