BLACK LIVES MATTER SUMMER CAMP

1

Name* This field is required.

First Name

Last Name

2

Email* This field is required.

example@example.com

3

Phone Number* This field is required.

Please enter a valid phone number.

4

How many children are you bringing with you? * This field is required.

5

Please type the names, and ages of all of the children whom you are bringing * This field is required.

6

Please type the shirt sizes for the children. If they are an adult size please indicate that. * This field is required.

7

Please tell us if you need any special accommodations * This field is required.

8

Any food allergies? * This field is required.

9

Indicate your sleeping accommodations. Cabins are limited * This field is required.

10

No pets are allowed at camp, do you understand this? * This field is required.

YESNO

11

Can you pay for camp or will you need a donation ticket? No family will be turned away.* This field is required.

I can pay

I need a donation ticket

12

Race/ethnicity of children * This field is required.

13

All parents are required to help at camp, how will you help? * This field is required.

15

Select the answer that you mean with your entire heart