EEIS Camp Registration Form

EEIS Summer & Intersession Camp Registration Form

Fill out the form carefully for registration
Student Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Name

First NameLast Name
Mobile Number

Area CodePhone Number
Home Number

Area CodePhone Number
Work Number

Area CodePhone Number
Email
example@example.com

My Products

Registration Fee$35.00

Quantity
Item subtotal:$0.00

Total $0.00

Credit Card

Should be Empty: