Registration Form (May 26 - July 25)

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

May 26 - May 30      $125

June 02 - June 06     $125

June 09 - June 13     $125

June 16 - June 20     $125

June 23 - June 27     $125

June 30 - July 04     $125

July 07 - July 11     $125

July 14 - July 18     $125

July 21 - July 25     $125

Security Code

 

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

Register