S.A.M Summer Camp Registration Form 2025

Summer Camp Registration
Student Information
Student's Name*

First NameLast Name
Birth Date*

MonthDayYear
Sibling's Name ATTENDING Camp (optional)

First NameLast Name
Sibling's Birth Date

MonthDayYear
Date
Sibling's Name ATTENDING Camp (optional)

First NameLast Name
Sibling's Birth Date

MonthDayYear
Date
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
Alternative Emergency Information Other than the name listed above
Emergency Contact's Name*

First NameLast Name
Relationship*
Emergency Contact 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 S.A.M Singapore Math and Bach to Rock during the selected camp.*

AgreeI do not agree
Media Disclosure S.A.M Singapore Math and Bach to Rock 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 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 Camp. You can also follow us on Facebook to capture all of the pictures yourself!*

I AgreeI do not agree
Price Registration Fee

Early Bird Special: $420/Weeks (by April 30)

Regular price: $450/week

Drop in: $100/day

10% off sibling discount on 2nd student
Please select your reservation*

June 02-06June 23-27July 07-11July 21-25August 04-08+ Add 10% Sibling discount
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.
Contact us:

Email: sandiegoca@seriouslyaddictivemath.com

Phone: 858-666-8200

Address: 7845 Highlands Village Pl C104, San Diego CA 92129
Signature*
Should be Empty:

Summer Camp Registration

Price Registration Fee