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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.
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* Indicates required question
Check The Session You Are Registering For
*
First Session (July 22 – July 25 & July 29 - August 1)
Second Session (August 12 – August 15 & August 19 – August 22)
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
*
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
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.
*
Child's friend
Child's school
Boys & Girls Club
Big Brothers & Big Sisters
Facebook
Instagram
Jersey City Spring Sports Expo
Parents As Partners Conference
Earth Day Fair
Other:
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 and half need-based scholarships are available for households earning less than $60,000 annually. Income verification is required.
Will you be applying for a scholarship?
*
Yes
No
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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