App YOUniversity Summer Mini Tech Camp Form

App YOUniversity Summer Mini Tech Camp Registration

Ben Salem Presbyterian Church has partnerd with the App YOUniversity Tech Program to host our App YOU Summer Mini Tech Camp. The camp will take place from Monday August 4th through Thursday August 7th from 6pm-8pm at 6801 Monroe Road, Charlotte NC 28212. Dinner will be Provded.We will accept the first 20 students. Upon filling all open spots, all additional submissions will be added to our waiting list.
CHILD INFORMATION:
Child Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade*
Name of School*
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail*
example@example.com
MEDICAL INFORMATION
Physician Name

First NameLast Name
Phone Number
Medical Concerns (including food allergies)
Please list all individuals designated for child pickup.
Should be Empty:

App YOUniversity Summer Mini Tech Camp Registration