Rising Mountain Academy Summer Camp Interest Form

Thank you for your interest in Rising Mountain Academy’s Summer Camp! Please note that this form is for interest purposes only and does not guarantee registration. Completing this form allows us to gather information on potential campers and keep you updated on camp details, availability, and the official registration process. Spaces are limited, and we will follow up with next steps once enrollment opens.

We appreciate your enthusiasm and look forward to an amazing summer! 🌞🏕️✨

Event Timing: June 2-July 18, 2025

Contact us at: (928)-224-2888 or support@risingmountainacademy.org 
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Email *
Camper's Full Name *
Camper's Date of Birth
Camper's ICD-10CM Primary Diagnosis
Grade Level (Entering Fall 2025) *
Allergies/Medical Conditions *
Dietary restrictions *
Special Accommodations Needed *
Parent/Guardian Information
Name, Phone Number, Relationship to Child
 *
Emergency Contact
Name, Phone Number, Relationship to Child
 *
Payment Information *
Required
We would like to schedule a meeting to learn more about your camper.  What are the best days and times to schedule this? (Please pick a day and a time) *
Required
A copy of your responses will be emailed to the address you provided.
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