Young Entrepreneurs Club Registration
Fall 2026 Lewis Elementary, Thursdays 2:30-3:30
Student Name
*
First Name
Last Name
Student Teacher
*
Student Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Student Grade
*
2nd
3rd
4th
5th
Parent/Guardian Information
The parents/guardian listed below will be the authorized person to pick-up the child after the camp.The parents/guardian listed below will also be the primary emergency contact person.
Parent/Guardian 1 Name
*
First Name
Last Name
Parent/Guardian 1 Mobile Number
*
Format: (000) 000-0000.
Parent Email
*
example@example.com
Parent/Guardian 2 Name
First Name
Last Name
Parent/Guardian 2 Mobile Number
Format: (000) 000-0000.
E-mail
example@example.com
Address
*
Street Address
Street Address Line 2
City
County
Postcode
Gender
Boy
Girl
Undisclosed
Allow Photos
*
Yes
No
Any allergies or Medical Conditions?
*
Yes
No
Please describe any allergies, chronic illness, or medical conditions?
After Club my child will be dismissed as:
*
ASP
Car Rider
Student T-Shirt Size
*
Youth Small
Youth Medium
Youth Large
Youth XL
Adult S
Adult M
Adult L
My Products
*
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Fall 2026 Young Entrepreneurs Club Registration
Meets Thursdays 2:30-3:30 and Includes a T-Shirt
$249.00
$
249.00
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
Afterpay
After submitting the form, you will be redirected to Afterpay to complete the payment.
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