Course Registration Form

Summer Bootcamp Registration Form

Fill out the form carefully for registration
MAAC Summer Learning Adventures Information
Student Name

First Name Middle Name Last Name
Birth Date

Month Day Year
Gender
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Student E-mail
example@example.com
Mobile Number
Parent E-mail
Parent Number
High School
Grade
What are your three favorite things about yourself? What are three things you would like to improve upon? How do you like to spend your free time? What made you choose to enroll in this 2-week summer bootcamp?
Summer Bootcamp Price
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Summer Bootcamp
$ 895.00

Total

$ 0.00
Should be Empty:

Summer Bootcamp Registration Form