MAD Camp 2019 Registration

* Indicates required field

Name of Child *

First

Last

School *

Grade Completed *

Address *

Birthday *

City *

Parent/Guardian Name *

Phone # *

E-mail address *

Phone # *

E-Mail Address *

Does your child have food allergies? If so list allergies *

Does your child have any other special needs or instructions that may require attention *

Who has permission to pick up your child? Please provide name and phone number. *

Untitled *

Your child's photo may be used in social media and promotional materials. Please let us know if you DO NOT want their photo's used. *

Submit

MAD Camp 2019