Inner City Youth Group - Summer Camp 2019
Join us at SAMARITAN CENTER - 5555 Conners, Detroit, MI 48213

Summer Camp enrollment form. The dates are July 8th - August 16, 2019, Monday thru Friday, 8-4pm. The cost is $140 for return 2018 participants and $175 for all others. This is the discount until June 3, 2019. There is a $25 registration fee per participant. You will receive an invoice immediately after registering.
INQUIRE about the multi-family discount..

Email address *
Student School *
Your answer
Student Full Name *
Your answer
Street Address *
Your answer
Zip Code *
Your answer
Primary Phone Number *
Your answer
Student T-Shirt Size (Y=Youth A=Adult) *
Date of Birth *
Your answer
Gender *
Ethnicity *
Your answer
How did you hear about this program? *
Parent/Guardian Full Name *
Your answer
Please select your relationship to the student *
Address (if different from the student's)
Your answer
Primary Phone Number *
Your answer
Email Address *
Your answer
Emergency Contact Name *
Your answer
Relationship to the student *
Your answer
Address (if different than the student)
Your answer
Message from Inner City Youth Group (You will receive an invoice which requires a 50% deposit which includes a $15 registration fee)
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Your answer
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