The New Freedom Summer Project Form
Coordinated by MS MOVE, One Voice MS and The Hollis Watkins Muhammad Human Development Foundation
Camper's name
*
First Name
Last Name
Parent/Guardian name
*
First Name
Last Name
Contact Phone Number
*
If not an emergency contact number, please provide one below
Email
example@example.com
Alternate Parent/Guardian name
First Name
Last Name
Alternate Phone Number
If not an emergency contact number, please provide one below
Camper Birthdate
*
-
Month
-
Day
Year
Date
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Relationship with Camper
Email
example@example.com
Signature (if under 18 y/o parent/guardian MUST sign)
Are You Signing up as
*
Participant/Camper
Volunteer
Other
How did you hear about the New Freedom Summer Camp?
*
Social Media
Radio Advertisement
Email Announcement
Word of Mouth
Other
Please verify that you are human
*
Submit
Should be Empty: