Summer Camp Registration Form
Please complete this form to request a spot in our Summer Camp. Spots are limited and will be secured once your $100 non-refundable deposit is received. The deposit will be applied toward your weekly tuition.
Parent/Guardian Full Name
*
First Name
Last Name
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email Address
*
example@example.com
Student Full Name
*
First Name
Last Name
Student Age
*
Student Grade (2026-2027 School Year)
*
Please Select
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
💛Child Support Needs 💛
We strive to support all learners. Please share any information that will help us create a positive experience for your child.
Does your child have any specific learning, behavioral, or support needs?
*
Yes
No
If yes, please share any details that would help us support your child: (learning needs, behavioral supports, sensory preferences, medical needs, etc.)
Allergies? Other pertinent medical info.
Select Camp Week(s)
*
June 8–11
June 15–18
June 22–25
Emergency Contact Name & Relationship
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Camp Policies & Agreement
Perferred Payment Method
*
Venmo (no processing fees)
Square Invoice (processing fees may apply)
Parent/Guardian Signature
*
After submitting this form, you will be directed to submit your non-refundable deposit to secure your child’s spot. If selecting, Venmo, please include your child’s name and selected week(s) in your payment note.
Submit
Submit
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