APPLICATION FORM
Parent Name
*
First Name
Last Name
Parent Email Address
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent Cell Phone
*
-
Area Code
Phone Number
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How many campers are you registering?
*
1
2
3
4
Camper 1 Name
*
First Name
Last Name
Camper 1 Age (as of June 30, 2017)
*
5
6
7
8
9
10
11
12
13
14
Please list any allergies or medical conditions for Camper 1
Camper 2
Camper 2 Name
*
First Name
Last Name
Camper 2 Age (as of June 30, 2017)
*
5
6
7
8
9
10
11
12
13
14
Please list any allergies or medical conditions for Camper 2
Camper 3
Camper 3 Name
*
First Name
Last Name
Camper 3 Age (as of June 30, 2017)
*
5
6
7
8
9
10
11
12
13
14
Please list any allergies or medical conditions for Camper 3
Camper 4
Camper 4 Name
*
First Name
Last Name
Camper 4 Age (as of June 30, 2017)
*
5
6
7
8
9
10
11
12
13
14
Please list any allergies or medical conditions for Camper 4
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ALTERNATE PICK UP: Please list any individuals in addition to parents who are permitted to pick up your child:
Rows
Name
Cell Phone Number
Relationship to Child
1
2
3
EMERGENCY CONTACTS: Please list 3 emergency contacts for your child(ren):
*
Rows
Name
Cell Phone Number
Relationship to Child
Emergency Contact 1
Emergency Contact 2
Emergency Contact 3
Was your child an IST student from September 2016 to June 2017?
*
Yes
No
For an additional fee, are you interested in aftercare for your child from 2pm - 4pm?
*
Yes
No
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Payment Information
Please select the number of campers you are registering. Note: all families must pay a non-refundable registration fee of $10.
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( X )
Camp Fee (per child)
$200.00
$
200.00
Number of campers you are registering
1
2
3
4
Item subtotal:
$0.00
$
0.00
Family Registration Fee
$10.00
$
10.00
Enter coupon
Apply
Total
$0.00
$
0.00
Submit
Should be Empty: