Monarch Academy

Summer Camp Registration

Step 1 of 2

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Summer Camp Registration

Student Information:
Student #1 Name*
First Last
Age*
School*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Phone*
Parent's Email*
Student's Email*
Select camp:*
- Rock Solid (July 8-12)
- Figure It Out (July 15-19)
- Magic of Storytelling (July 22-26)
- Sketchorama (July 29 - Aug 2)
- The Great Outdoors (Aug 5-9)
- Acrylic Madness (Aug 12-16)
Add another child?*
- Yes
- No
Student #2 Information:
Student #2 Name*
First Last
Age*
School*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Phone*
Parent's Email*
Student's Email*
Select camp:*
- Rock Solid (July 8-12)
- Figure It Out (July 15-19)
- Magic of Storytelling (July 22-26)
- Sketchorama (July 29 - Aug 2)
- The Great Outdoors (Aug 5-9)
- Acrylic Madness (Aug 12-16)
Add another child?*
- Yes
- No
Student #3 Information:
Student #3 Name*
First Last
Age*
School*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Phone*
Parent's Email*
Student's Email*
Select camp:*
- Rock Solid (July 8-12)
- Figure It Out (July 15-19)
- Magic of Storytelling (July 22-26)
- Sketchorama (July 29 - Aug 2)
- The Great Outdoors (Aug 5-9)
- Acrylic Madness (Aug 12-16)
Parent Guardian #1 Information
Parent Guardian #1 Name*
First Last
Cell Phone*
Place of Work*
Work Phone*
Parent Guardian #2 Information
Parent Guardian #2 Name*
First Last
Cell Phone*
Place of Work*
Work Phone*
Emergency Contact #1 Information
Emergency Contacts Information*
First Name Last Name Phone Relationship to Child
Child resides with*
- Parent #1
- Parent #2
- Guadian
- Both
- Other
Other
Alternative Person(s) for Picking Up Child(ren)

If you have an alternative person you would like to authorize to pick up your child(ren), please list them below.
Alternative Person #1 for Picking Up Child(ren)*
First Name Last Name Phone Relationship to Child
Alternative Person #2 for Picking Up Child(ren)*
First Name Last Name Phone Relationship to Child
Any special instructions, such as custody or restraining orders must be attached to this application and discussed personally with the camp director. All information will be kept confidental.
Drop files here or
Any medical information/allergies that we need to be aware of
Please list any other information you'd like to include about your camper:
Parent Signature*
Date
Date Format: MM slash DD slash YYYY

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First Name	Last Name	Phone	Relationship to Child

First Name	Last Name	Phone	Relationship to Child

First Name	Last Name	Phone	Relationship to Child

Monarch Academy

Step 1 of 2

Summer Camp Registration

Student Information:

Student #2 Information:

Student #3 Information:

Parent Guardian #1 Information

Parent Guardian #2 Information

Emergency Contact #1 Information

Alternative Person(s) for Picking Up Child(ren)

@