Exploration in Tech Camp for Kids Grades 6-12 Registration Form

Please fill in all required fields for each child you are registering for. 

Child Information

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Parent/Guardian Contact Information

Only one Parent/Guardian is required, but please fill out contact information for both if the child has more than one Parent/Guardian.
Please fill out if different than Parent/Guardian #1

Alternate Pickup/Release

Please fill this out if someone else other than a Parent/Guardian will be picking the child up.
Name

Medical Release Information

Emergency Contacts

Please list at least one emergency contact.

Parent/Guardian Authorizations

Parent/Guardian's Initials
Parent/Guardian's Initials
Printed Name of Parent/Guardian
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