NorthBay Summer Center Registration - Middle School
Please fill out each section and submit this information for acceptance. Deposit is required to secure registration.
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Email *
Student's First Name *
Student's Middle Initial
Student's Last Name *
Student's Gender *
Grade student will be entering (Fall 2021) *
Students Date of Birth (MM/DD/YYYY) *
Student's Age (as of June 1, 2021) *
Student's Street Address / P.O. Box Number
Zip Code
School District
Current School
Program Session *
Top 2 Track Choices *
T-Shirt Size (unisex adult) *
Parent/Guardian First Name *
Parent/Guardian Last Name *
Parent/Guardian Telephone Number *
A $200 non-refundable deposit is required to secure your spot
Checks can be made out to NorthBay Education, Inc. and mailed to 11 Horseshoe Point Ln. North East MD, 21901. Credit card transactions have a 3% fee can be & completed through this form or over the phone at 443-967-0500. A receipt will be emailed to the attached email address.
Payment Options
Full name on Card
Card Number
no spaces or dashes
Expiration Date
Security code
The three digit code on the back of the card (4 digit code on the front of American Express cards)
Billing Address
This is the address associated with the card
Amount Approved
Please write in the amount you would like to pay in full at this time.
Please complete the esign health and covid-19 testing forms using the link below.
If your child requires any medications, you must also download the Medication Authorization Form and return with the prescribing physicians signature
Please send forms, any other information you would like to share, or questions you have to or call 443-674-9034.
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This form was created inside of NorthBay Adventure.