SmARTen Up! Summer Camp Registration

Parent/Guardian Information
Parent/Guardian #1 Name*

First NameLast Name
Cell Phone Number *
Please enter a valid phone number.
Email *
example@example.com
Parent/Guardian #2 Name

First NameLast Name
Cell Phone Number
Please enter a valid phone number.
Email
example@example.com
Primary Address
Camper(s) Primarily Resides With*

Parent/Guardian #1BothParent/Guardian #2Other
Address*

Street Address

Street Line 2

CityState

Zip Code

Transportation & Emergency Contacts
Please list the name(s) of any individual(s), in addition to parents/guardians listed above, who are cleared to transport your camper(s) to and from camp and whom we may contact in the event a parent/guardian cannot be reached.
Additional Individual 1

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.
Additional Individual 2

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.

Allergies & Medical Conditions
Does your camper(s) have any allergies, chronic illnesses, or medical conditions? If yes, please describe. If no, write "none": *
Does your camper(s) have any medications that they will need to take during the course of the camp day? (If YES, you will be contacted for additional info prior to camp)*

YesNo
Would you like to be considered for a scholarship?

YesNo
What level of scholarship would you like to be considered?

FullHalf

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