NYCHAPS History Camp Application
Student and Family Information
July 13-17, 2026
Student Name
*
First Name
Last Name
Prefers to be called
Entering Grade (choose one)
*
4th
5th
6th
Parent Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
I grant permission to NYCHAPS to use photographs and/or video of my child taken while attending History Camp in publications, new releases, online and other communications related to the mission of NYCHAPS.
*
YES
NO
*
Categories:
All
All
Education
prev
next
( X )
Member Fee
$125.00
$
125.00
Non-Member Fee
$135.00
$
135.00
Credit Card
Please verify that you are human
*
Signature
*
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: