2025 - 2026 Summer Camp Registration Form

Summer Camp Registration Form

Complete this form to register for one or both camps and provide necessary details.

Summer Camp Options

Mad Scientist Camp: Cosmic Lab

June 1st -4th

8 a.m. to 11:30 a.m.

$278.37 Select a payment option
Item subtotal:

7 Wonders Camp

June 1st - 4th

12:00 p.m. to 3:30 p.m.

$278.37 Select a payment option
Item subtotal:

Lunch time break

11:30 a.m. - 12:00 p.m.

*Only available for students enrolled in both camps.

Bring a sack lunch.

Free

Total

Credit Card Payment
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Student Information
Student Full Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Grade
T-Shirt Size
Parent/Guardian Information
Parent/Guardian Full Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact
Emergency Contact Name

First NameMiddle NameLast Name
Relationship to Student
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Policies and Expectations

Please review the PLM Student/Parent Handbook for summer camp. It is the customer's responsibility to familiarize him or herself with policies and guidelines.
2025/2026 Summer Camp Student/Parent Handbook
Medical Information

Paradigm Learning Microschools does not staff medical personnel, have a nurse's office, or distribute medication.
Allergies
Special Needs or Accommodations
Additional Medical Notes
Payment
Payment Responsibility Agreement

I agree that I am responsible for all payment obligations related to this registration. If paying with a personal credit card, the full balance is due today. Payments made through Zelle, check, cash, or ESA must be paid or submitted for payment within 48 hours of receiving a separate invoice. I understand my child will lose his or her seat if payment is not made within this timeframe. No refunds will be given after May 15, 2026.
Final Fields
Signature
Date

MonthDayYear
Date
Should be Empty:

Summer Camp Registration Form

Summer Camp Options*

Student Information

Parent/Guardian Information

Emergency Contact

Policies and Expectations

Medical Information

Payment

Final Fields

Summer Camp Options