Team Wilderness Summer Session Pre-registration Form
This must be completed by a parent or legal guardian. No section may be completed by a child.
Check The Session You Are Registering For *
STUDENT INFORMATION
Child's Full Name *
Your answer
Birth Date *
MM
/
DD
/
YYYY
Address (include zip code & apt # if applicable) *
Your answer
Student E-Mail Address *
Your answer
Confirm Student E-Mail Address *
Your answer
Student Cell Phone *
Your answer
Gender *
Your answer
Grade Level in September *
School in September *
Your answer
FAMILY INFORMATION
Primary Guardian Name *
Your answer
Relationship to Child *
Your answer
Primary Language *
Your answer
Home Address If Different From Child (include zip & apt # if applicable) *
Your answer
Cell Phone *
Your answer
Home Phone
Your answer
Workplace
Your answer
Work Phone
Your answer
Primary Guardian E-mail *
Your answer
Confirm E-mail *
Your answer
Secondary Guardian Name
Your answer
Relationship to Child
Your answer
Primary Language
Your answer
Home Address (include zip & apt # if applicable)
Your answer
Cell Phone
Your answer
Home Phone
Your answer
Workplace
Your answer
Work Phone
Your answer
E-mail
Your answer
Confirm E-mail
Your answer
One Quick Question
How did you hear about us? Please check all that apply. *
Required
Registering Together
If siblings or friends register together, then the $50 registration fee will be halved. If you are registering with someone include their name below.
Your answer
SCHOLARSHIPS
Full scholarships are awarded to households earning less than $60,000 annually. Half scholarships are awarded on an as-needed basis. Income verification is required.
Will you be applying for a scholarship? *
NEXT STEP
Within a day of submitting this application you will receive an e-mail with instructions on paying the registration fee.
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