CAMP Registration Form

CAMP Student Registration Form

Fill out the form carefully for registration
Student Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Student's Current Grade blanks
Current School blanks
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent #1 Name

First NameLast Name
Parent #1 Phone Number
Please enter a valid phone number.
Parent #1 E-mail
example@example.com
Parent #2 Name

First NameLast Name
Parent #2 Phone Number
Please enter a valid phone number.
Parent #2 E-mail
example@example.com
Emergency Contact Name

First NameLast Name
Emergency Contact Number
CAMP Philly Location
Choose site that your student will attend.
Courses
Course Selection is Subject to Appropriate Placement and Approval
Courses
Course Selection is Subject to Appropriate Placement and Approval
Courses
Course Selection is Subject to Appropriate Placement and Approval
Courses
Course Selection is Subject to Appropriate Placement and Approval
Signature

Clear
Additional Comments
Should be Empty: