SUPER STAR SUMMER CAMP APPLICATION
Camper Information
Last Name *
Your answer
First Name *
Your answer
Middle Name
Your answer
Nick Name
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Age *
Your answer
Address Line 1 *
Your answer
Address Line 2
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Has your child been identified with dyslexia?
Is your child adopted?
Is English your child's first language?
If not, what age did your child begin to speak English?
Your answer
How did you hear about the "Every Child Reading" Super Star Camp Program?
Your answer
Contact and Mailing Information
Every Child Reading
2017 Summer Camp Program

4EveryChildReading@gmail.org

Make checks payable to: Every Child Reading
Application fees and documents should be sent to:
Every Child Reading
7435 East Maple Ave, Denver, CO 80230

Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms