Life Academy and Summer Camp Mentoring Registration
Fill out the form carefully for registration
Student Name
*
First Name
Middle Name
Last Name
Student E-mail
*
example@example.com
Gender
*
Please Select
Male
Female
N/A
Student Phone Number
*
Please enter a valid phone number.
Parent Name
*
First Name
Last Name
Parent Email
*
example@example.com
Parent Phone Number
*
Please enter a valid phone number.
List of Classes
*
Please Select
Summer Camp
Positive Thinking Skills
Elevation
Leadership
Financial Intelligence
Infinity
Initiative
Driver Responsibility
Distracted Driver
Bullying Prevention
Substance Abuse Prevention
Marijuana Prevention
Truancy Prevention
Vaping Awareness
Anger Avoidance
Boundaries
Self Awareness
Youth/Parent
Minor in Possession
Conflict Resolution
Cyberbullying
Stealing
Decision Making Skills
Showing Up
Thoughts=Consequences
Submit
Should be Empty: