Summer Camp Registration Form

Name of child

Name to be displayed on name tag:

Gender

Parent/Guardian Name

Address

City

State

Zip Code

Phone Number

E-Mail Address

Tshirt Size Please identify the tshirt size of the participant

Emergency Contact Number In the event of a medical emergency please list the number that we should attempt to contact the parent/guardian first

Physician Name

Physician Contact Number In the event of a medical emergency please list the number that we should attempt to contact the child's physician

Allergies

Participant School 2018-19 Please identify the school your child attended this year

Participant Grade Please identify what grade the participant was in during the 2018-19 academic year

Participant School 2019-20 Please identify the school the participant will be attending in August 2019

Participant Grade Level Please identify the grade level to which the participant is advancing (Must be 4-12)

Overnight Lock-In Will the participant be staying overnight on Thursday, July 25, 2019

Interest Statement Please provide a brief statement reflecting the participant's interest in social justice. This statement should also reflect the participant's family commitment to this process.

Family Project Reflection

Release Form

Thank you for applying for the Social Justice Youth Camp. Please be anticipating additional information upon completion of application.

Office of Institutional Equity

Summer Camp Registration Form