Summit Academy Summer Camp Registration Form 2024
July 1-19, 2024
Camper's Name:
Camper's Age:
Gender:
Male
Female
Grade/Class in September:
Current School:
Date of birth
-
Month
-
Day
Year
Date
Mother's Name:
First Name
Last Name
Mother's email address:
Mother's Cell Number
-
Area Code
Phone Number
Father's Name:
First Name
Last Name
Father's email address:
example@example.com
Father's Cell Number:
-
Area Code
Phone Number
Name of emergency contact (other than parent)
Phone number of emergency contact:
Please register my child for:
Week 1 (July 1-5)
Week 2 (July 8-12)
Week 3 (July 15-19)
Does your child have any restrictions, medical needs, allergies, etc.?
Is your child medically cleared for sports?
Yes
No
Unsure
Has your child been diagnosed with Autism, a learning difference or behavioral challenges?
Yes
No
If you answered "yes' above, please explain below:
May we include photographs of your child on the school's social media accounts?
Yes
No
Please list the names of anyone authorized to collect your child
Payment Options
Bank transfer (please contact the office for wiring instructions)
Office Payment
Student Activity Account Deduction
Please add to my June tuition invoice (returning/incoming Summit Academy students only)
Other
Name of parent/guardian completing form
First Name
Last Name
Submit
Should be Empty: