Junior CTA Registration Form 2019
Please fill out separate forms if you are signing up multiple children.

Grades 2- 5
Email address *
Participant Information
Participant's Last Name *
Your answer
Participant's First Name *
Your answer
Street Address *
Your answer
City/State/Zip *
Your answer
Entering grade *
Indicate session(s)- $100 for one, $150 for both *
Does your child have any medical conditions that may pose a risk to them at camp? If so, a separate email will be sent to you so we can further discuss your child's needs. *
Emergency Contact Information
Parent/Guardian available during camp
Name *
Your answer
Relationship *
Your answer
Cell Phone Number *
Your answer
Participation and Image Use Waiver
I have read and understand the participation and image use waiver. *
By entering your initials on the line below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge. *
Your answer
Payment
Payment of $100 or $150 will be made via... *
Survey Questions
(optional)
How did you hear about CTA?
How many previous years have you attended Junior CTA?
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