EmailMeForm
Shaw University Summer Camp - 2015
Please complete the registration form below, and select the camp(s) you would like to attend. Fields marked with an * are required.
Please select registration type:
*
Registering one child
Registering multiple children
Shaw University employee
Select all that apply
Camper(s) Information
First Name
Last Name
Grade Level (2014-2015)
Gender
Camper 1
Camper 2
Camper 3
Camper 4
Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
Does the camper(s) require any special accommodations to participate in this program/activity?
*
Yes
No
If yes, please explain special accomodations:
PARENT/GUARDIAN INFORMATION
Parent/Guardian Name
*
First
Last
Primary Phone
*
###
-
###
-
####
Work Phone
###
-
###
-
####
Email
*
If Shaw University Employee, please enter @shawu.edu email
Is address same as child?
Yes
No
Parent Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
EMERGENCY CONTACT
Emergency Contacts
*
Contact Name
Relationship
Contact Number
Emergency Contact 1
Emergency Contact 2
CAMP SELECTION
Camp
*
Youth Bible Camp - June 15-20 ($250)
Science Camp - 15-19 ($150)
Math Camp - June 22-26 ($100)
Math Camp - June 29-July 3 ($100)
Art Camp - July 6-10 ($100)
NOTE: Camps are organized by start date
Camp (discount rate already applied)
*
Youth Bible Camp - June 15-20 ($225)
Chemistry is Fun Camp - June 15-19 ($125)
Math Camp - June 22-26($75)
Math Camp - June 29-July 3 ($75)
Art Camp - July 6-10 ($75)
NOTE: Camps are organized by start date
Budget Code (Internal Use)
Payment Selection
*
Pay by Credit Card
Pay by Check
Total
$0.00
