Mahalia Jackson CAMP Registration SUMMER SESSION 2019
Mahalia Jackson Elementary School partnered with Columbia College of Chicago School of Fine and Performing Arts SUMMER PROGRAM runs Monday, JULY 8, 2019 until Thursday, AUGUST 1, 2019 Monday Through Thursday 9:00 until 1:00 PM.

ELIGIBILITY REQUIREMENTS
-95% Attendance Average
- Grade C Average or above
-Behavior recommendation from Teacher(s) and Dean of Students


PLEASE COMPLETE AN APPLICATION FOR EACH CHILD ENROLLED. FAMILIES WITH MULTIPLE CHILDREN COMPLETE A APPLICATION FOR EACH CHILD.


A confirmation will be sent to email provided.

Your child CANNOT start the program without receiving a written confirmation.

Email address *
Student First Name
Your answer
Student Last Name
Your answer
Student Middle Name
Your answer
Student Date of Birth
MM
/
DD
/
YYYY
Student Current Grade
Your answer
Gender
HOW MANY CHILDREN (SIBLINGS) ARE YOU REGISTERING? PLEASE COMPLETE A SEPARATE APPLICATION FOR EACH CHILD.
Your answer
What are their name(s) and Grade(s)?
Your answer
Parent Name
Your answer
Parent Phone Number
Your answer
Emergency Contact Name
Your answer
Emergency Contact Relationship
Your answer
Emergency Contact Phone Number
Your answer
Does your child have any allergies?
If yes, please indicate?
Your answer
Does your child have any special needs?
If yes, please indicate?
Your answer
Please list student hobbies and interest:
Your answer
A copy of your responses will be emailed to the address you provided.
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