CareerBOOST Summer Camp Registration- For Transition Aged Youth
Hosted by AccessAbility
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Birthday
*
-
Month
-
Day
Year
Date
Gender
*
Please Select
Male
Female
Other
Race (Select all that apply)
*
American Indian/Alaska Native
Black or African American
Native Hawaiian or other Pacific Islander
Asian
White
Hispanic/Latino
Disability (Please Specify)
*
What highschool did you attend or graduate from? (Write in below)
*
Do you currently have an IEP/504?
Yes
No
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please select the session or multiple sessions that you would like to register for: (topics are subject to change)
Session 2- Conflict Resolution/Self-Defense (June 17th)
Session 3- Nutrition (June 24th)
Any Dietary Restriction?
Yes
No
List any Restrictions
Thank You
Submit
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