Creative Camp Application
Name
First Name
Middle Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
School District You Attend
Texarkana Arkansas Independent School District
Texarkana Texas Independent School District
Liberty Eylau Independent School District
Pleasant Grove Independent School District
Red Lick Independent School District
Genoa Central School District
Premier Highschool-Texarkana
Grade Level
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Pronouns (Please check all that apply):
He/Him/His
She/Her/Hers
They/Them/Theirs
Email
example@example.com
Phone Number
School Reference
First Name
Last Name
School Reference Email
Example Jamesdoe@lesid.net
Shirt Size ( Adult Size)
Small
Medium
Large
XX Large
XXX Large
XXXX Large
Interest
Film & Photography
Graphic Design & Art
Creative Writing & Ideas
Business & Entrepreneurship
Back
Next
Medical Information
Does the camper have allergies including asthma?
Please explain on the field provided
Is the camper currently under medication?
Please provide the details, the name of the medication and period of intake
Back
Next
Contact Information in Case of Emergency
Name
First Name
Last Name
Contact Number
-
Area Code
Phone Number
Relation to camper
Name
First Name
Last Name
Contact Number
-
Area Code
Phone Number
Relation to camper
Back
Next
Signature of applicant or guardian representative
Submit
Submit
Should be Empty: