Summer Camps and Classes 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:

Type in the text that you see above: