PLC Enrollment
We are happy to have your student at our Pivotal Leaders Camp, a leadership series with 2 sessions offered this summer. Students will leave with more confidence in their decision-making abilities, stronger relationships, and new skills like 3D printing, engineering, intentional writing, and problem-solving.

Please take 10-15 minutes to ensure we are prepared to serve your child in the best way possible. Remember to mark the proper session you would like to register your student(s) for.

Enrollment is flexible - please read below.
  • Single day ($15/day)
  • Weekly ($45/week)
  • 5-week series ($200/series)
Logistics
Dates: June 20th-July 20th
Days & Time: Thursday-Saturday | 9am-1pm
Location: 9307 Monroe Rd, Charlotte NC (Upscale Studio & Events)
Site Contact: Jasmine Cox | (704) 701-7371 | admin@pivotsocialservices.org

What to Expect
  • 9-9:30 - Drop-off
  • 9:30-10:00- Student-led activities & Collaborative challenges
  • 10:00-11:00- Rotating Clubs
  • 11-12 - Pivotal Leaders Life Skills
  • 12-1- Creative Challenge - show what you know!
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Email *
What series are you registering for? *
Parent/Guardian Information
Please fill out the information below for primary guardian.
Full Name *
Phone Number *
Email Address *
Student Information
Please list student demographics below. If enrolling more than one student, please see below.
Student Full Name ( + preferred name if applicable) *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Raising Grade Level (Fall 24') *
School
Student Full Name ( + preferred name if applicable)
Date of Birth
MM
/
DD
/
YYYY
Gender
Clear selection
Raising Grade Level (Fall 24')
School
Emergency Contact Full Name *
EC: Phone Number *
EC: Relationship to Student *
EC #2 Full Name
EC #2 Phone Number
EC #2 Relationship to Student
Medical Information
Allergies or Medical Conditions:
*
Medications:
Liability and Release
Please read carefully and sign to register your student for camp.
I certify that I am the parent/legal guardian of the above-named student list. I hereby give permission for my child to participate in Pivotal Leaders Camp and I understand that staff will uphold an environment of safety and care. In addition, I understand that participation in camp activities involves a certain degree of risk. I hereby release and hold harmless Pivot Social Services, its staff, and volunteers from any and all claims resulting from injuries, illnesses, damages, or losses which may arise from participation in the camp.
*
Payment Information
The registration fee for camp is $45/week
Weekly registration available - payment due Monday of each camp week.

Payment can be made via Venmo or Zelle.
Zelle: admin@pivotsocialservices.org
Venmo: pivotprincess
Call 704-701-7371 for any support.

Please include your child’s full name in the payment note for reference. Select your method below.

*
Required
Rolling registration available!
We are so excited to support your student in becoming the leader they're destined to be.
Site Director Contact Information
Jasmine Cox 704-701-7371

Important Notes
Thurs-Sat 
Drop Off: 9:00-9:30am
Location: 9307 Monroe Rd, Charlotte NC
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