Creative Camp Registration 2017

Student Name: *
First Name
Middle
Last Name
Student date of birth:*
Please choose a shirt size.
What is the age of your student? *
Choose Preferred Activity *
Choose Preferred Activity *
Choose Preferred Activity *
Choose Preferred Activity *
Please list special needs, allergies or other concerns.
Parent or Guardian Name (This will be considered the Emergency Contact.) *
First Name
Middle
Last Name
Mailing address: *
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Contact phone number:*
Email Address:
Emergency contact (if different from above):
Is there a friend your student would like to be with during our activity? Please list the friends name here.

Need to register more than one student?  Click here!