Coldharbour Youth Education Registration
We are so excited for this summer's youth education programming! Please register your child below by selecting the program you wish for them to participate in. After registering, you will receive an invoice for payment and waivers. Once payment is made, your child's spot is secured. Please send any questions to mj.pickett@coldharbourinstitute.org
Email address *
Camper Name (First and Last) *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Second Child's Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Program you will attend *
Required
Parent or Guardian Contact Name (First and Last) *
Your answer
Parent or Guardian Contact Email *
Your answer
Parent or Guardian Contact Phone *
Your answer
Preferred Point of Contact *
Emergency Contact (Name and Phone) *
Your answer
Emergency Contact (Name and Phone) *
Your answer
Camper Medical Information
Your answer
Camper Dietary Restrictions
Camper Allergies
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy