Course Registration Form

Phonics Enrichment Camp | Registration Form

Fill out the form carefully for registration.
Student Name *If You'd Like To Register More Than (3) Students, Please Email Course Coordinator Julie Dixon-Borum at julie.borum@stmarcus.org For Further Registration Instructions.*

First NameMiddle NameLast Name
Student 2

First NameLast Name
Student 3

First NameLast Name
Birth Date*

MonthDayYear
Gender*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Guardian: First & Last Name*
example@example.com
Primary Guardian: Email*
Format: (000) 000-0000.
Phone Number*
Format: (000) 000-0000.
Relationship To The Student*
Format: (000) 000-0000.
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Summer Phonics Enrichment Camp
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Phonics Enrichment Camp | Registration Form