Camp Registration PLEASE NOTE: All camps take place at our Medford location. Student InformationStudent's Name* First Last Student's Date-Of-Birth* MM slash DD slash YYYY Student's Grade Level for the 2024/2025 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 AcademyAdventure Academy - Incoming 2nd-5th Graders Choose 1, 2, 3 or all 4 weeks of camp: June 24-27th, 9-12:00 July 8-11th, 9-12:00 July 15-18th, 9-12:00 July 22-25th, 9-12:00 Adventure Academy - Incoming 2nd-5th Graders - with 8am Early Drop-Off Choose 1, 2, 3 or all 4 weeks of camp: June 24-27th, 9-12:00 July 8-11th, 9-12:00 July 15-18th, 9-12:00 July 22-25th, 9-12:00 Adventure Academy - Incoming 5th-8th Graders Choose 1, 2, 3 or all 4 weeks of camp: June 24-27th, 12:30-3:30 July 8-11th, 12:30-3:30 July 15-18th, 12:30-3:30 July 22-25th, 12:30-3:30 Success in High School August 5-7th, 10am-2:00pm Enroll in Success in High School - $195.00 TotalIf you have a coupon code, enter it here. Grand Total $0.00 Credit Card Cardholder Name Card Details NameThis field is for validation purposes and should be left unchanged.