Camp Registration Student InformationStudent's Name* First Last Student's Date-Of-Birth* MM slash DD slash YYYY Student's Grade Level for the 2022/2023 School Year* Parent's Name* First Last Email* Enter Email Confirm Email Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent's Phone*Parent's Cell PhoneFood Allergies or Restrictions:Health or Medical Conditions we need to be aware of:Anything else you’d like us to know:Emergency Contacts1st Contact's Name* First Last Relation* Phone*2nd Contact's Name* First Last Phone*Relation* Release Form* I have read and agree to the terms outlined in the camp release form (pdf). CampsSummer Success AcademySummer Success Academy For incoming 2nd-7th Graders FULL SUMMER : June 21-August 18 JUNE: JULY AUGUST Bridge the GapJune 27-Aug 3, Mondays/Wednesdays Enroll - Incoming 4th-6th Grades: 11:30AM-1:30PM +$495 No Thanks Little EinsteinsAges: 3-5 (fully potty trained). August 23-25 - Tues, Wed, Thurs. Enroll +$99 No Thanks TotalIf you have a coupon code, enter it here. Grand Total $0.00 Clicking the link below will redirect you to PayPal to complete payment and registration. You are not registered until we receive your payment.Payment Method*PayPal Checkout MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name CommentsThis field is for validation purposes and should be left unchanged.