Youth Camp Application Form
STEAM Max Camps are designed for children ages 8-14 and participants for these camps must fit within this age range. Components of the class include science, technology, engineering, art and math. Camps are from 8am until 3pm each day. Please plan for timely drop-off and pick-up. Lunch will be provided each day.

Public Safety Careers Camp is designed for children ages 9-12 and it explores careers in public safety areas including fire, law enforcement, emergency medical services, and emergency management. Each day campers will enjoy demonstrations from multiple local public safety departments and have fun participating in hands-on activities. All attendees will come away with better understanding of public safety career opportunities as well as safety tips and skills.

Register your child here or in person at Van Dusen Hall at Sandhills Community College. You will need to return required signed document. Questions? Contact Danaka Bunch, bunchd@sandhills.edu or call 910-695-3980.

Which camp(s) are you interested in?
Student First Name *
Your answer
Student Last Name *
Your answer
Student Middle Name
Your answer
Mailing Address *
Your answer
City *
State *
Zip Code *
Your answer
Student Date of Birth *
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DD
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YYYY
Age *
Highest Grade Completed *
Gender *
Race *
Child T-Shirt Size *
Parent Name *
Your answer
Parent Email Address *
Your answer
Parent Cell Phone *
Your answer
Parent Work Phone
Your answer
In Case of Emergency Contact Name *
Your answer
In Case of Emergency Contact Phone Number *
Your answer
In Case of Emergency Contact Relationship to Student *
Your answer
In Case of Emergency Contact Name 2
Your answer
In Case of Emergency Contact Phone Number 2
Your answer
In Case of Emergency Contact Relationship to Student 2
Your answer
Name of Person with Permission for Pickup *
Your answer
Relationship to Child of Person with Permission for Pickup *
Your answer
Name of Person with Permission for Pickup 2
Your answer
Relationship to Child of Person with Permission for Pickup 2
Your answer
I will be responsible for picking up my child promptly at the end of class. *
Required
EMERGENCY MEDICAL TREATMENT
Please provide information of any medical or behavioral conditions, allergies, medications, or special needs of your child of which the staff and faculty should be aware
Your answer
In the event that my child should require emergency medical treatment and reasonable attempts to contact me have been unsuccessful, I give my consent for emergency medical treatment deemed necessary by the licensed physicians or dentists at a nearby medical facility of preference. *
Required
Name of Insurer *
Your answer
Policy Number *
Your answer
Family Physician *
Your answer
Phone Number *
Your answer
How did you hear about our youth enrichment offerings?
May we text you from (910) 315-0664?
Payment Contact Information (Name/Business, Phone and Email) *
Your answer
COMPLETE AND SIGN ALL REQUIRED FIELDS ON THE FORM AT THIS LINK AND RETURN BY EMAIL, FAX OR MAIL AS NOTED ON THE FORM.
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