Summer Day Camp Registration Form

1. Student Name Required

2. Student Age Required

3. Student Birthdate Required

Help: MM/DD/YYYY

4. Grade Required

5. School District/Homeschool Required

6. Parent or Guardian's Name Required

7. Street Address Required

8. City Required

9. State

10. Zip Required

11. Home Telephone Required

12. Cell Telephone

13. Insurance Company

14. Policy Number

15. Work Telephone

16. Email Address Required

17. Emergency Contact Name Required

18. Emergency Phone Number Required

19. Relationship Required

20. Please check the activity (ies) that your child will be attending

Vertebrate Anatomy Camp Field Biology Camp

21. How did you hear about our program? Check as many as apply

22. If Other, please describe where.