Camp Elevate

Lamad Educational Services, LLC

JUNE 3-28, 2018

Camper's First Name: Enter Name

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Email: Enter Email

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Cell Phone: Enter Phone Number

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Home Phone: Enter Phone Number

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Billing City: Enter City

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Billing State: Enter State

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Billing Zip code: Enter Zip

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Camper's Last Name: Enter Text

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Camper's Grade in Fall 2019: Enter Grade

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Full Name: Enter Text

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Work Phone: Enter Phone Number

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Full Name: Enter Text

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Cell Phone: Enter Text

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Email: Enter Text

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Work Phone: Enter Text

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Full Name: Enter Text

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Relationship to the Camper: Enter Text

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Phone: Enter Text

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Please list any person (s) authorized to pick up your child Enter Your Message

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Please list any allergies Enter Allergies

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Please list any medical conditions we should know about Enter Medical Conditions

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Billing Address: Enter Address

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Camper's Gender:

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Male

Female

Birth Date: Enter Birth Date

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Doctor's Name: Enter Doctor's Name

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Doctor's Phone: Enter Phone

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Preferred Medical Facility (In Case of Emergency) Enter Text

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How will the Camper Arrive to Camp Each Day? (Walking, Car, etc.): Enter Text

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How will the Camper Get Home Each Day? (Walking, Car, etc.): Enter Text

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I will pay in person on or before registration.

Parent/Guardian 1

Parent/Guardian 2

Emergency Contact Information

Pick-Up

Medical

Billing

Please click the "Submit" button before moving on to the payment page. If you are planning to pay in person, there is no need to go to the next page. Payments must be made on or before registration day.

Education is not the filling of a pail but the lighting of a fire.

- William Butler Yeast

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graphic designs & social media management