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)
Parent Name *
Parent Name
Parent Phone *
Parent Phone
Second Guardian Name
Second Guardian Name
Second Guardian Phone
Second Guardian Phone
Allowed to pick up student? *
Emergency Contact *
Emergency Contact
Emergency Contact Phone *
Emergency Contact Phone
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