SCA Camp Ignite Registration
A summer program for children entering kindergarten through 6th grade.
Session Dates: *
You may sign up for as many sessions as you would like. The cost is $85/week for SCA Scholars and $100/week for non-SCA Scholars.
Required
Camper's Name: *
Your answer
Camper's Birthdate: *
MM
/
DD
/
YYYY
Camper's Gender: *
Grade Camper will Enter in 2019-2020: *
Camper Address: *
Your answer
City: *
Your answer
State: *
Your answer
Zip Code: *
Your answer
Areas of Interest: *
Please choose the activity strands that your child would be interested in participating. You may choose more than one.
Required
Parent/Guardian's Name: *
Your answer
Parent/Guardian's Address: *
If different from the camper's address listed above
Your answer
Parent/Guardian's Preferred Phone Number: *
Your answer
Preferred Email Address: *
Your answer
Emergency Contact: *
Your answer
Emergency Contact's Phone Number: *
Your answer
Emergency Contact's Relationship to Child: *
Your answer
ALL Persons Authorized to Pick-Up Scholars (other than parent/guardian listed above): *
Please include all names, phone numbers and relationship with the child. Photo ID will be required for pick-up.
Your answer
Please list any allergies and/or health or medical concerns that IGNITE staff should be aware of: *
If there are no concerns, answer with none.
Your answer
Next
Never submit passwords through Google Forms.
This form was created inside of Scintilla Charter Academy. Report Abuse - Terms of Service