Summer Camps Registration:

1.
*

Student Last Name
2.
*

Student First Name
3.
*

Student Middle Name
4.
*

Gender
5.
*

Date of Birth
6.
*

Street Address (Apt #)
7.
*

City
8.
*

State or Country
9.
*

Zip Code
10.
*

Name of Current School
11.
*

Student resides with
12.
*

Mother/Guardian: First Name/Last Name
13.
*

Phone number of Mother/Guardian
14.
*

Father/Guardian: First Name/Last Name
15.
*

Phone number of Father/Guardian
16.
*

US Citizen
17.
* Student ethnicity
African American   Asian or Pacific Islander
Caucasian   Hispanic
Native American   Oriental
Biracial
18.

Please register me in the following Summer Classes:

Class Name                               Class Session            Class Time
19.

I would like more information on Summer Classes. Please contact me.
by phone
by email

* Enter Your Email Address: