Summer Camp Registration Request
All camps and classes are filled on a first come first serve basis. This submission does not guarantee placement in the camp and is contingent on receipt of payment.

Students First name:

Last name:

Age:

Sex: --- Female Male

Birth Date:

Address:   

City:

State:

Zip:

Home Phone:	Cell Phone:
Email Address:
Parents's Name:	Bus. Phone:

Camp Name	Date of Camp	Time	Tuition