Summer Camp Registration Session 2

Email*
example@example.com
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Emergency Contact Name & Number*
How many children are you signing up? (up to 6 may be signed up with this form)*
Do you receive SNAP benefits, medicaid, or within the federal poverty guidelines?

SNAPMedicaidBelow federal poverty (see chart above)Combination of the 3 above

This information is for child 1. If you only have one child just skip to the next section after completing this part.