Camp Elevate

LAMAD

Educational Services, LLC

Learning to be Successful

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Camper's First Name: Enter Name

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Email: Enter Email

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Phone: Enter Phone Number

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Phone: Enter Phone Number

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City: Enter City

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State: Enter State

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Zip code: Enter Zip

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Camper's Grade in Fall 2019: Enter Text

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Camper's Last Name: Enter Text

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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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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 Camper: Enter Text

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Billing Address: 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 Your Message

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Please list any medical conditions we should know about. Enter Your Message

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Phone: Enter Text

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Camper's Gender:

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Male

Female

Camper's Birth Date: Enter Text

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Doctor's Name: Enter Text

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Preferred Medical Facility (In Case of Emergency) Enter Text

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Doctor's Phone: 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

Billing

Emergency Contact Information

Pick-Up

Medical

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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