SixTwelve Camp Enrollment Form

Student Name *
Student Name
Please enter the name of the camp you are enrolling your child in. Thank you!
Birth Date *
Birth Date
Primary Address *
Primary Address
Secondary Address (if applicable)
Secondary Address (if applicable)
Primary Parent/Guardian Name *
Primary Parent/Guardian Name
Primary Parent/Guardian Phone *
Primary Parent/Guardian Phone
Second Guardian Name
Second Guardian Name
Second Guardian Phone
Second Guardian Phone
Allowed to pick up student? *
Emergency Contact (other than Primary Contact) *
Emergency Contact (other than Primary Contact)
Emergency Contact Phone (other than Primary Contact) *
Emergency Contact Phone (other than Primary Contact)
Do we have permission to call 911 in case of an emergency? *
Social Media/Website Photography Release *
Do we have permission to photograph your child and share images online either on social media or our websiste for the purposes of documentation of programming and advertising?
Today's Date *
Today's Date