NPBC Building STEA2M Summer Camp 2020

Camp Registration Form

Question Title

1. Camper First Name

Question Title

2. Camper Last Name

Question Title

3. Camper Gender

Female

Male

Question Title

4. Camper Birthdate (MMDDYYYY)

Date / Time

Date

Question Title

5. Family Information

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

Question Title

6. Camper Grade for Fall 2020

Question Title

7. Camper Current School

Question Title

8. Camper Ethnicity

African American

Hispanic

Caucasion

Mixed

Other (please specify)

Question Title

9. Emergency Contact Name

Question Title

10. Emergency Contact Number

Question Title

11. Does your child have any food allergies or medical conditions we should be aware of?

Yes

Please specify

Question Title

12. Which weeks to you plan to attend? Check all that apply.

Week 1: June 1st - June 5th

Week 2: June 8th - June 12th

Week 3: June 15th - June 19th

Week 4: June 22nd - June 26th

Week 5: June 29th - July 2nd (short week: $128)

Week 6: July 6th - July 10th

Week 7: July 13th - July 17th

Week 8: July 20th - July 24th

Week 9: July 27th - July 31st

Question Title

13. We will likely need before care (7:30-8:30 am)

Yes

Question Title

14. We will likely need after care (4:30 - 5:30 pm)

Yes

Question Title

* 1. Camper First Name

Question Title

* 2. Camper Last Name

Question Title

* 3. Camper Gender

Question Title

* 4. Camper Birthdate (MMDDYYYY)

Question Title

* 5. Family Information

Question Title

* 6. Camper Grade for Fall 2020

Question Title

* 7. Camper Current School

Question Title

* 8. Camper Ethnicity

Question Title

* 9. Emergency Contact Name

Question Title

* 10. Emergency Contact Number

Question Title

* 11. Does your child have any food allergies or medical conditions we should be aware of?

Question Title

* 12. Which weeks to you plan to attend? Check all that apply.

Question Title

* 13. We will likely need before care (7:30-8:30 am)

Question Title

* 14. We will likely need after care (4:30 - 5:30 pm)

1. Camper First Name

2. Camper Last Name

3. Camper Gender

4. Camper Birthdate (MMDDYYYY)

5. Family Information

6. Camper Grade for Fall 2020

7. Camper Current School

8. Camper Ethnicity

9. Emergency Contact Name

10. Emergency Contact Number

11. Does your child have any food allergies or medical conditions we should be aware of?

12. Which weeks to you plan to attend? Check all that apply.

13. We will likely need before care (7:30-8:30 am)

14. We will likely need after care (4:30 - 5:30 pm)