Summer Camp Registration Form
Waxhaw Homeschool Enrichment
Student 1 Name
First Name
Last Name
Student 1 Birthday
-
Month
-
Day
Year
Date
Student 2 Name
First Name
Last Name
Student 2 Birthday
-
Month
-
Day
Year
Date
Student 3 Name
First Name
Last Name
Student 3 Birthday
-
Month
-
Day
Year
Date
Family Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent 1 Name
First Name
Last Name
Parent 2 Name
First Name
Last Name
Parent E-mail
example@example.com
Parent Cell Number (For Calls and Texts)
Format: (000) 000-0000.
Secondary Phone number/ Emergency Contact
Format: (000) 000-0000.
Courses
Please Select
Summer Session 1:June 10-July 1
Summer Session 2: July 15-August 5
Summer Session 3: Both Sessions
Summer Session 3 includes BOTH Sessions
Please List ALL Food Allergies AND Medical Issues Here:
Once we receive your registration, an invoice for tuition will be sent to the email provided above.
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Family Registration Fee
$25.00
$
25.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card
Submit
Should be Empty: