LCCAA ACT Boot Camp Registration 2018

Lorain County Community Action Agency ACT Boot Camp

Monday, July 16th-Thursday, July 19th

9 AM- 1 PM

506 Broadway Avenue

Lorain, OH 44052

Breaks will be provided. Students may bring a snack or lunch.

First:

Last:

Student Birth Date

Student Home Phone

Student Cell Phone:

Student Email Address:

Parent Name:

Parent Email:

Parent Cell Phone:

Mailing Address (Street, City, Zip Code)

Lorain High School

Other (please specify)