Commissioner Henri E. Brooks District 7 Summer Youth Pre-Enrollment Form 2026
Please complete this pre-enrollment form for your organization's summer youth camp program.
Organization Name
Summer Camp Coordinator
Organization Top Executive (Person Responsible for Program)
Camp Mailing Address - Street
Camp Mailing Address - City
Camp Mailing Address - State
Camp Mailing Address - Zip Code
Camp Street Address
Organization EIN
Date Camp Started
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Number of Campers
Anticipated Camp End Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Programs Offered
Reading
Lunch & Snacks
Technology
Outdoor Activity
Swimming
Board Games
Field Trips
Writing Activity
Math Enrichment
Personal Time
Physical Activity
Parental Involvement
Arts & Crafts
Programs Offered - Other (free text 1)
Programs Offered - Other (free text 2)
Programs Offered - Other (free text 3)
Programs Offered - Other (free text 4)
MSCS Food Bank Training Completion Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Shelby County Commission District
Certification Agreement
I certify that the above information is true and correct to the best of our knowledge.
Certifying Officer of Organization (Name/Signature)
Position
Certification Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
Should be Empty: