Parent First Name

Parent Last name

Email

Phone

Emergency Contact Name

Emergency Contact Phone Number

Email

Child's First and Last Name

Age

Gender

Male

Female

School Attending

Special Needs/Allergies/Medical Information

Allergies (if any)

Medical Conditions:

We would love to capture photos/videos of your child during activities to share on our website, social media, and marketing materials. Do we have your permission to do so?

Yes

No

Field Trip Consent

Yes

No

Policies and Liability Waiver

Agree

Camp Policies and Liability Waiver

Parent/Guardian Signature

Signature field is empty.

Registration Form

Our Programs

AMC 8

Spanish

Creative Writing

Music