2023 Project Pipeline Student Registration Form

Parent/Guardian Info

Locations: Downtown Raleigh; Uptown Charlotte. Dates: Wednesday, July 12 - Sunday, July 16. Time: Dropoff 8-9 AM. Camp 9AM-4PM. Pickup 4-5 PM. The registration deposit is $25 and refunded upon completion of the camp. Registration scholarships are also available. The registration deadline is June 28. Please email ncnoma@gmail.com with any questions. Thank you!
Primary Parent/Guardian/Educator/Mentor Name*

First NameLast Name
Contact Email*
example@example.com
Phone (We will only contact you for an emergency)*

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Info
Student Name*

First NameLast Name
Student Gender*
Student Race*
Student Email*
example@example.com
Student School*
Student Age*
Student Grade Level in Fall 2023*
Student Interests

ArchitectureSocial JusticeArtMathEnvironmentMusicPoliticsEngineeringScienceSports
Student T-Shirt Size*
Student Dietary Restrictions
Has this student participated in Project Pipeline before? If yes, what year(s)?*
Documentation

As a parent or guardian of this student, I hereby consent to the use of photographs/videos taken during the course of the camp for publicity, promotional and/or educational purposes (including publications, presentation or broadcast via newspaper, internet or other media sources) as well as survey information for camp reports and documentation. I do this with full knowledge and consent and waive all claims for compensation for use, or for damages.
Information Release*

Yes, I give consent to use my child's information for camp purposes.No, I do not give consent to use my child's information.
How did you hear about Project Pipeline?*

My Products

Registration Deposit$25.00

This registration deposit is fully refunded for students who are active and maintain full participation and completion of the summer camp. Please select your camp location.

Camp Location

Enter coupon

Total $0.00

Payment Methods

Debit or Credit Card

First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Please click one of the PayPal options to complete payment and submit the form.

Should be Empty:

Parent/Guardian Info

Student Info