Summer 2022 Virtual Camp Registration

Student First Name: *

Student Last Name: *

Student's DOB (XX/XX/XXXX): *

Student's Cell Phone

Student's Email Address

Student Gender *

Male

Female

Non-Binary

PARENT #1 INFORMATION

Parent # 1 First Name

Parent # 1 Last Name

Parent # 1 Home Phone

Parent # 1 Work Phone

Parent # 1 Cell Phone

Parent # 1 Email Address *

PARENT #2 INFORMATION

Parent #2 First Name

Parent #2 Last Name

Parent #2 Home Phone

Parent #2 Work Phone

Parent #2 Cell Phone

Parent #2 Email Address

I understand that by enrolling in an online virtual class, my child's image will be viewable by other camp participants, as well as by friends and families of the campers who may be sent completed camp materials(including zoom recordings)to view. *

Yes

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