Junior Black Campers Registration
Thank you for Registering for Junior Black Campers. We want to get to know you and our new camper. 
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Parent First Name *
Parent Last Name *
Email *
Address *
Phone number *
Emergency Contact Information *
Camper First Name *
Camper Last Name *
Camper Age *
What are some things your kid struggles with? *
What are some things your kid excels in? *
Has your kid ever  *
Required
What are some goals you have for your Child? *
Are you interested in volunteering? *
What would you like to gain from Junior Black Campers *
Have you ever *
Required
Are you interested in tutoring? *
Are you attending the Info session Dec 11, 2024 5:30p at the Shively library? *
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