Information about the student
Student's name. First and last. Required
Student's date of birth, required.
Student's age at beginning of camp/event.
Gender student identifies with.
Street address where student resides. Be sure to include city, state, and zip code.
Student's phone number or a number we can call with event/camp related information/updates.
Student's email address, or one we can use for event/camp related information/updates
legal guardian name (first and last)
legal guardian phone number if different than one listed for student above.
legal guardian address if different than one listed for student above
We collect this data for Federal Grants and demographic information.
Please check the boxes if you qualify for either or both of the following:
PLEASE READ CAREFULLY. THIS IS A LEGAL DOCUMENT THAT AFFECTS YOUR LEGAL RIGHTS.
Type your name if you agree. This will act as your electronic signature.
This is a filler space for what Kaleidoscope Discovery Center will put to describe what the person is registering for.