Summer Camp Registration 2024

Master Minds Tutoring Summer Camp Registration

Pre-K thru 6th
Camp registration ends May 27, 2024
Student Information
Student's Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade COMPLETED in May 2024*

Pre-KindergartenKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade
Sibling's Name ATTENDING Camp (optional)

First NameLast Name
Grade Completed in May 2024 (optional)

Pre-KindergartenKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Information
Name*

First NameLast Name
Cell Number*

Area CodePhone Number
E-mail*
Confirm E-mail*
example@example.com
What STATE & COUNTY does your child attend school in?*
Emergency Information Other than the name listed above
Emergency Contact's Name*

First NameLast Name
Relationship*
Emergency Contact Phone Number*

Area CodePhone Number
Alt. Phone Number

Area CodePhone Number
Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by Master Minds Tutoring, LLC during the selected camp. Master Minds Tutoring, LLC is not responsible for increased grades in school. However, we do guarantee providing each student with developmentally appropriate tasks, strategic lessons, and researched based content to improve their reading and/or math performance.
AgreeI do not agree
Media Disclosure (insert tutoring name here) may periodically photograph students participating and working during camp. These photographs may be used in a variety of ways; Public relations and marketing purposes: images printed on brochures, posters, and newsletters, or on (insert tutoring name here) Website, Facebook Page, and/or other art, education, or news related publications. Please indicate whether you will allow publication of photographs taken of your child/children and their literacy work during classes. Names will not be included in photographs or posted on social media. We appreciate your support and would love the chance to share pictures of all of the fun being had at our Summer Reading Camp. You can also follow us on Facebook to capture all of the pictures yourself!
AgreeI do not agree
Price Registration Fee: $20
Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
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Registration for Summer Camp includes completion of the registration form and the registration fee. Students are not enrolled until both are received.
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Master Minds Tutoring Summer Camp Registration

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