ECA Summer Camp Registration Form

ECA Summer Camp Registration

Register for Summer Camp at ECA. All students will attend each session (Spanish, Coding & Art on a rotation basis) Pre-K must be fully potty trained and able to communicate clearly with the teacher. This is a Christian environment and all staff, students and parents are expected to act in a Christlike manner at all times. Please submit payment on dyfeca.org and click payments (indicate Summer Camp in notes)
Student Name *

First Name Last Name
Birth Date *

Month Day Year
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email
example@example.com
Grade Level in 2022-2023
If Pre-K, is your child fully potty trained (you will be required to pick up your child if an accident occurs)

Yes No
Which Week will your child be attending?

Week 1: June 7-10 Week 2: June 13-16 Both Weeks Virtual Coding Week 1: June 7-10 Virtual Coding Week 2: June 13-16
Allergies/Medical Conditions
T-Shirt Size

Youth XS Youth S Youth M Youth L Youth XL 4T-5T Adult Small
Emergency Contact Name & Phone Number
List all who can pick up your child with Phone Number
My child has permission to ride the ECA Bus to and from the field trip and ECA is not liable for any accident or harm caused.

Yes No, I will drive my child
Parent Signature

Clear
Should be Empty:

Now create your own Jotform - It's free! Create your own Jotform