PTC Summer Camp

Summer Camp 2026 Registration

May 26-28, 2026 | 8:15 - 11:30 am FOR STUDENTS ENTERING 6TH OR 7TH GRADE IN PIONEER TECH DISTRICT: Complete the form and pay the non-refundable, non-transferrable $25 camp fee. Transportation will be provided from Blackwell High School, Newkirk High School, Tonkawa High School, and Woodland High School. Deadline for enrollment forms is May 1, 2026 or until a group is filled. Late applications are permitted only if slots are available. REMINDER POSTCARDS WILL BE SENT 1-2 WEEKS BEFORE CAMP. YOU MUST FILL OUT THE FORM COMPLETELY. For more information or questions call (580) 718-4234
Student Information
Student's Name*

First NameLast Name
Birth Date

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
MaleFemale
6th7th
BlackwellNewkirkPonca CityTonkawaWoodlandOther
Group A: Automotive, Criminal Justice, Culinary Arts, Health Careers, Information Technology/Visual Communication (combined), WeldingGroup B: Biomedical Sciences, Construction, Cosmetology, Electronics-Automation-Robotics, Firefighter/EMT, Precision Machining
Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XLAdult XXL
Parent/Guardian Information
Name*

First NameLast Name
Cell Number*
Format: (000) 000-0000.
E-mail*
example@example.com
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Format: (000) 000-0000.
Alt. Phone Number*
Format: (000) 000-0000.
Current medical conditions/food allergies and medications (please list)
Family Doctor's Name & Phone Number*
Insurance Company & Policy Number*
Photo Release

I give permission for the use of the above participant’s photographic likeness in preparation and distribution of all promotional material including advertising, brochures, displays, public relations activities, pamphlets, signs, still photography, and video promoting the services, classes, and functions attesting to the positive well-being of Pioneer Technology Center in Ponca City, Oklahoma. Conditions of this release state that all photographs remain the property of Pioneer Technology Center. YOU MUST FILL OUT THE FORM COMPLETELY.
Health Release

By my electronic signature below, I give permission for PTC staff to act on my behalf to take measures deemed necessary in the event of sickness or injury during Summer Camp. I agree to pay for any medical expenses for my child whose name appears above.
Nondescrimination Policy

Pioneer Technology Center does not discriminate on the basis of sex, race, color, national origin, disability, age, or any other characteristic protected by law, and prohibits sex discrimination in any education program or activity that it operates, as required by Title IX and its regulations, including in admissions and employment. For inquiries concerning the application of this policy, contact compliance@pioneertech.edu; Wendy Burg, (580) 718-4308 or wendyb@pioneertech.edu; or Kellie Johnson, (580) 718-4224 or kelliej@pioneertech.edu, Compliance Officers/Title IX Coordinators; or Carol Lynes, (580) 718-4298 or caroll@pioneertech.edu, 504/ADA Coordinator. Pioneer Technology Center, 2101 N. Ash, Ponca City, Oklahoma 74601.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

My Products*

Single Summer Camp Registration

$25.00

Enter coupon

Total

$0.00

Credit Card

Permission

I give my permission for the above participant to participate in all the Pioneer Technology Center Summer Camp activities.
Date

MonthDayYear
Date
Signature
Should be Empty:

Summer Camp 2026 Registration

Credit Card