Camp Registration

Summer Camp Registration Form

Fill out the form carefully for registration
Student Name

First NameMiddle NameLast Name
Student Date of Birth

MonthDayYear
Address

Street Address

CityState / Province

Postal / Zip Code
Parent/Guardian

First NameLast Name
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
Parent/Guardian #2

First NameLast Name
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
Student Diagnosis
Any allergies:
Does your student have seizures?
If yes, please upload any necessary seizure plans for your student

Cancelof
Do you have any behavioral concerns at this time?
Primary Doctor
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
My child has attended a previous camp at SLC
Emergency Contact Name
This person is allowed to pick up my student (must have valid ID at time of pickup):
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Winter Camp

$350.00

Enter coupon

Total

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Summer Camp Registration Form