Women in Blue Leadership Camp Registration
Complete the form below to reserve your student’s spot for this exciting one-day leadership camp. Registration is required!
Student Name
*
First Name
Middle Name
Last Name
Student Age
*
E-mail
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Birth Date
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
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31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
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2003
2002
2001
2000
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1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Current School
*
Please Select
Atascadero Middle School
Fine Arts Academy
Atascadero High School
Paloma High School
Other
Are you currently an Atascadero Resident?
*
Please Select
Yes
No
Food allergies or dietary restrictions
*
If none, put "N/A"
Other medical conditions or accommodations
*
Primary Guardian Full Name
*
FIRST AND LAST NAME
Relationship to child
*
Phone Number of Guardian
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address of Guardian
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact (1)
*
FIRST AND LAST NAME
Phone Number (1)
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact (2)
*
FIRST AND LAST NAME
Phone Number (2)
*
Please enter a valid phone number.
Format: (000) 000-0000.
Submit
Should be Empty: