Alma Learning Lab: 2026 Summer Camp Enrollment Form
Student Information
Student Name
*
First Name
Last Name
Student Date of Birth
*
-
Month
-
Day
Year
Date
Grade level for 2026/2027 school year
*
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Parent/Guardian Information
Parent/Guardian 1
Name
*
First Name
Last Name
Email
*
example@example.com
Phone
*
Please enter a valid phone number.
Parent/Guardian 2
Name
First Name
Last Name
Email
example@example.com
Phone
Please enter a valid phone number.
Parent/Guardian 3
Name
First Name
Last Name
Email
example@example.com
Phone
Please enter a valid phone number.
Parent/Guardian 4
Name
First Name
Last Name
Email
example@example.com
Phone
Please enter a valid phone number.
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Emergency contact
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
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Week selection
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Week 1: May 26-29
$
160.00
Quantity
1
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10
Week 3: June 8-12
$
200.00
Quantity
1
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10
Week 4: June 15-19
$
200.00
Quantity
1
2
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8
9
10
Week 5: June 22-26
$
200.00
Quantity
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Week 6: June 29-July 3
$
200.00
Quantity
1
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Week 7: July 6-10
$
200.00
Quantity
1
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10
Week 8: July 13-17
$
200.00
Quantity
1
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10
Week 9: July 20-24
$
200.00
Quantity
1
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10
Week 10: July 27-31
$
200.00
Quantity
1
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10
Week 11: August 3-7
$
200.00
Quantity
1
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10
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Should be Empty: