Summer School Registration Form

Summer Camp Student Registration Form
Camp Registration $50

Choose 1, 2, or 3 Weeks of Camp- $150 per week

Registration Fee Waived for students enrolled full-time in the 2025-2026 School Year.
Student 1 Name*

First NameMiddle NameLast Name
Student 2 Name

First NameMiddle NameLast Name
Student 3 Name

First NameMiddle NameLast Name
Student 4 Name

First NameMiddle NameLast Name
Mother's Name*

First NameLast Name
Father's Name*

First NameLast Name
Student 1 Birth Date*

MonthDayYear
Student 2 Birth Date

MonthDayYear
Student 3 Birth Date

MonthDayYear
Student 4 Birth Date

MonthDayYear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
Mother's Mobile Number*

Area CodePhone Number
Father's Mobile Number*

Area CodePhone Number
Emergency Contact*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
Emergency Contact's Relationship to Student
Any diet restrictions or allergies we need to be aware of?
I give permission for my child’s photograph and/or video to be posted on any co-op-related publications, including websites, public and private Facebook pages or newsletters.
June 10, 11, 12July 15,16, 17August 5, 6, 7
Additional Comments
How did you hear about us?
Payment

You will receive an invoice in the next week, after which you may submit payment in cash or send a check to 18 Cunningham Road, Taylors, SC 29687
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Summer Camp Student Registration Form