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PWB Summer Camp Registration
Student Name
First Name
*
Last Name
*
Grade Level
*
6th
7th
8th
Freshman
Sophomore
Junior
Senior
Please select the grade your student will enter in the 2022-2023 academic year.
What is your interest in attending this camp?
*
Please let us know if we need to provide any individualized options for your child.
*
Special Accommodations (mobility challenges, medical conditions, etc.)
Known Food Allergies/Sensitivities (nuts, gluten, etc.)
Vegetarian Meal
None
Other
If you selected "Other," please specify:
Additional Comments:
Parent/Guardian
First Name
*
Last Name
*
Email
*
Emergency Contact
*
Please enter contact name and relationship to the child. EXAMPLE: Jane Smith, aunt
Emergency Contact Phone
*
HBAGC Membership Info
Company Name / Member Contact
*
Please tell us the member company you work for and/or who recommended this camp program to you.
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Pay Invoice
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