Summer Camp Registration

Select Your Academic Camp: *

First Name *

Last Name *

Student's Email (must be unique) *

Gender *

Birthdate (YYYY-MM-DD) *

Street *

City *

Country *

State *

Zip Code *

Mother's Email

Father's Email

High School Name

High School Graduation Year *

College Entry Term *

When I go to college I am interested in studying *

Preferred Phone

Mobile Phone *

Home Phone *

Have you personally accepted Jesus Christ as your Savior? *

T-Shirt Size *

Emergency Contact - Name and Phone *

Please list any dietary restrictions, special housing needs, or roommate requests.

Comments

A payment request email will be sent to both student and parent email addresses.