New Student/Camper Intake Form

New Student/Camper Intake Form

PARENT/GUARDIAN 1 INFORMATION

* Parent/Guardian 1 - First Name

* Parent/Guardian 1 - Last Name

* Parent/Guardian 1 - Email Address

* Parent/Guardian 1 - Mobile Phone

* Parent/Guardian 1 - Address

* Parent/Guardian 1 - City

* Parent/Guardian 1 - State

* Parent/Guardian 1 - Zip Code

* Is there a second parent/guardian?

PARENT/GUARDIAN 2 INFORMATION

* Parent/Guardian 2 - First Name

* Parent/Guardian 2 - Last Name

* Parent/Guardian 2 - Email Address

* Parent/Guardian 2 - Mobile Phone

* Does Parent/Guardian 2 live at the same address as Parent/Guardian 1?

Parent/Guardian 2 - Address

Parent/Guardian 2 - City

Parent/Guardian 2 - State

Parent/Guardian 2 - ZIP

STUDENT/CAMPER INFORMATION

* How many Student/Campers are being registered?

STUDENT/CAMPER
1 INFO

* Student/Camper 1 - First Name

* Student/Camper 1 - Last Name

* Student/Camper 1 - Date of Birth

STUDENT/CAMPER
2 INFO

* Student/Camper 2 - First Name

* Student/Camper 2 - Last Name

* Student/Camper 2 - Date of Birth

STUDENT/CAMPER
3 INFO

* Student/Camper 3 - First Name

* Student/Camper 3 - Last Name

* Student/Camper 3 - Date of Birth

Thu, November 21 2024 20 Cheshvan 5785