Course Registration Form

Registration Form

Fill out the form carefully for registration
Student Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent E-mail
example@example.com
Work Number
Format: (000) 000-0000.
Parent name
Emergency contact
Emergency contact number
Will you need after care?
Please select the week for attendance
Courses dates
A non-refundable deposit of $100 per student is required at the time of registration to secure a spot in the camp.

The remaining balance must be paid on or before the first day of camp. Registration is not considered complete until the deposit has been received.
Parent Signature
Additional Comments

Deposit of $100

non-refundable deposit

$100.00 Quantity

Total

Credit Card

Cash App Pay

Mobile Number
Format: (000) 000-0000.
Does your student have allergies? Food or topical allergies?
Please example identify any allergies
Should be Empty: