Sunrise SEL Summer Camp Application
Camper Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Please Select
Male
Female
Other
Grade/Level
*
Please Select
Prek
Kinder
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Medical Insurance
*
Please Select
Commercial
Medicaid
Uninsured
Insurance Plan
Id Number
Any existing medical conditions or allergies
*
Please Select
Yes
No
Parent/Guardian Full Name(s)
*
First Name
Last Name
Parent/Guardian Full Name(s)
First Name
Last Name
What feels most stressful for your child right now?
Homework completion
Staying organized
Test anxiety
Falling behind in a subject
Motivation
Time management
Contact Information
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
What type of program are you interested in? (select all that apply)
Sports / Recreational Camp
Academic / Tutoring Camp
Social-Emotional Learning (SEL)
Combination (Sports + Academics)
What time works best for your child?
Morning (9 AM – 12 PM)
Midday (12 PM – 3 PM)
Evening (4 PM – 7 PM)
Flexible
Which area is most convenient for you?
Alief
Southwest Houston
Katy
Flexible
Preferred payment option:
Insurance (if eligible)
Weekly rate (up to $50)
Open to either
Additional Comments or Special Requests
Would you like to volunteer?
*
Yes
No
*
*
Signature
Submit
Submit
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