L0U Summer Camp Registration 2026

Summer Camp Registration

For (add grade level + subject area)
Student Information
Student's Name

First NameLast Name
Birth Date

MonthDayYear
Grade COMPLETED in May 2026
Sibling's Name ATTENDING Camp (optional)

First NameLast Name
Grade Entering in Aug 2026 (optional)
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
What STATE & COUNTY does your child attend school in?
Emergency Information Other than the name listed above
Emergency Contact's Name

First NameLast Name
Relationship
Emergency Contact Phone Number

Area CodePhone Number
Alt. Phone Number

Area CodePhone Number
Did you "Refer a Friend"? Please tell us the registered camper you invited who hasn't been to our Summer Reading Camp before!
Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by (insert tutoring name here) during the selected camp. (insert tutoring name here) is not responsible for increased grades in school. However, we do guarantee providing each student with developmentally appropriate tasks, strategic lessons, and researched based content to improve their reading and/or math performance.
Media Disclosure (insert tutoring name here) 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 (insert tutoring name here) 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 Reading Camp. You can also follow us on Facebook to capture all of the pictures yourself!
Price Registration Fee Early Bird Special Until April 3,2026 Non-Refundable $50 after registration is $125. Camp Weekly fee is $100 each child. Field Trips are an extra fee.
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.
Signature
Checkout

Registration includes registration fee and camp T-Shrit. Students are not enrolled until full payment is received.
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Camp Registration
Includes T-Shirt

$50.00

Total

$0.00
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Summer Camp Registration

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