Summer Camp 2014 - Pre-Application

2014 SUMMER CAMP PRE-APPLICATION

Space is limited. Middle school students interested in the Cheza Nami summer Camp-2014 are invited to complete the pre-application form below. Selected students will be informed on July 7th. Selection will be based on the level of funding after the close of the fundraising campaign. If our fundraising goal is reached, our camp will be able to accommodate up to 45 students and it will be on a first come first served basis. Completion of the form below does not guarantee you selection for the program.

* Indicates required field

Applicant Name *

First

Last

Birth Date *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

School *

Current Grade? Select One *

Parent Name *

First

Last

Parent Email *

Parent Primary Phone Number *

Parent Alternative Phone Number *

Submit Pre-Application form