Summit Academy Summer Camp Registration Form 2022
July 4-29, 2022
Camper's Name:
Grade in September:
Current School:
Date of birth
-
Month
-
Day
Year
Date
Parent's Name:
First Name
Last Name
Parent's email address:
Alternate email address:
example@example.com
Emergency contact (other than parent)
Parent's Number
-
Area Code
Phone Number
Please register my child for:
Session A (July 4-8)
Session B (July 11-15)
Session C (July 18-22
Session D (July 25-29)
Does your child have any restrictions, medical needs, allergies, etc.?
Is your child medically cleared for sports?
Yes
No
Unsure
Will your child be traveling internationally within five days of attending camp? If so, he/she will not be allowed to attend.
Payment Options:
Office Payment due by June 28th
Student Activity Account Deduction
Please add to my June tuition invoice (current/incoming Summit students only)
Phone number of emergency contact:
Name of parent/guardian completing form
First Name
Last Name
Submit
Should be Empty: