Pre-College Design Summer Camp Form

*denotes a required field

Primary Contact Email for Communication*

Student Information

First Name*

Middle Name

Last Name*

Gender

Birthdate*

Student's Age*

Current School*

Grade Level*

Expected Graduation Date*

Email Address*

Phone Number*

Permanent Address*

Country

Street

City

Region

Postal Code

Are you interested in our college readiness add-on program?*

Which format are you interested in?*

What is your primary reason for considering our camp?*

Other consideration

How did you hear about our camp?*

Other way you heard about camp

Do you have any specific questions or concerns?

Which program are you interested in?*

Guardian Information

Guardian First Name*

Guardian Last Name*

Phone Number*

Email*

Relationship to Student*

Emergency Contact Information

Emergency Contact First Name*

Emergency Contact Last Name*

Email*

Phone Number*

Primary Address*

Country

Street

City

Region

Postal Code

Relationship to Student*

ADA Accommodations

Do you require any accommodations?

If yes, please specify the type of accommodations needed.