SUMMER CAMP & INTENSIVE REGISTRATION FORM

Please fill out the registration form below.

Questions? We can be reached by telephone at 716.204.8192 or email.

Summer Camp & Intensive Registration Form

Student Name*
First Last
DOB*
Date Format: MM slash DD slash YYYY
Age*
Parent(s) Name*
Does your child have any allergies?*
Address*
Street Address City ZIP / Postal Code
Phone (Cell)*
Phone (Home)
Phone (Work)
Email(s)*
Student School (if applicable)
Requested Camps or Intensives*
Referred by:
Fees*
- Summer Camp/Intensive Deposit - $50
Comments
This field is for validation purposes and should be left unchanged.