Summer Camp Registration
Registration Form and Release Waiver for Summer Camp
Student Name: *
Your answer
Sex: *
Required
Date Of Birth: *
MM
/
DD
/
YYYY
Address: *
Your answer
Cell Number: *
Your answer
Work Number:
Your answer
Email Address: *
Your answer
Are there any medical conditions to which we should be informed? *
If yes, please explain:
Your answer
Parent(s) Names *
Your answer
Has this student ever been enrolled with us before?
In case of an emergency and we are unable to reach you, please list two (2) additional emergency contacts. *
Your answer
I allow my child to be photographed, videotaped, or recorded for educational, training, advertising, and web site purposes. *
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