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Student First Name
Student Last Name
Student Birthday
Parent First Name
Parent Last Name
Email
Parent Phone Number
Emergency Contact Name / Relationship
Emergency Contact Phone Number
Please describe any medical/behavior history that would be necessary for us to know so we may serve your student to the best of our ability. Ex.- mild ADHD
Please describe any known food allergies your student has.
How did you hear about Elevate?
Who has permission to pick up my child (please list full legal name)
Is this your first time attending Elevate?
*
Yes
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I understand the terms and conditions of my camp purchase.
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