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 2025/2026 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). Camps*Early bird pricing before 5/10/25 **If concurrently enrolled in Summer Tutoring, contact our office for a discount! Summer CampsAdventure Academy - Incoming 2nd-6th Graders Choose 1, 2, 3 or all 4 weeks of camp: July 7-10th, 9-12:00 July 14-17th, 9-12:00 July 21-24th, 9-12:00 July 28-31st, 9-12:00 Middle School Success July 29-31st, 12:30-3:30 Success in High School August 5-7th, 10-2:00 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.
