Elementary Lego Spike Essentials Summer Camp Registration
Register for our Elementary Lego Spike Essentials summer camp by entering your details and selecting your preferred date below. An individual child can be registered for multiple sessions with one submission, but please fill out a separate registration for each child/participant.
Participant Name
*
First Name
Last Name
School Attending
*
Age
*
Grade
*
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Other
Home Zip Code
*
Does the student have any medical needs/special considerations?
*
Yes
No
Allergies (food, environmental, medication):
Medications Needed During Camp:
Medical Conditions or Special Considerations:
Parent or Guardian Name
*
First Name
Last Name
Parent or Guardian Email Address
*
example@example.com
Parent or Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Relationship
*
Is there an additional emergency contact different from parent or guardian listed above?
*
Yes
No
Emergency Contact Name
First Name
Last Name
Emergency Contact Email
example@example.com
Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Relationship
Class dates (choose):
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next
( X )
June 22-26, 1-3PM (Great Adventures)
$
185.00
August 3-7, 1-3PM (Quirky Creations)
$
185.00
August 17-21, 1-3PM (Happy Traveler)
$
185.00
Payment Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
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