Registration Form (June 3 - July 26)

Student Information

First Name

Last Name

D.O.B. (MM/DD/YY)

Gender

Home Address

City

State

Zip

Allergies

Special Needs

Parent Information

Parent Name

Cell Phone 1

Cell Phone 2

Email Address

Physician Information

Name

Address

Contact Number

Dates

June 3 - June 7         $100

June 10 - June 14     $100

June 17 - June 21     $100

June 24 - June 28     $100

July 1 - July 5         $100

July 8 - July 12       $100

July 15 - July 19     $100

July 22 - July 26     $100

Security Code

 

By clicking this check box, I completely read and understood the terms and conditions of Gurukul Summer Camp

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