D.E.B’s Summer Camp Registration

Step 1: Registration Form

Fill out one form per student.
Once you have completed a form, you will be redirected to the “Quick Links” page to complete the registration process.
Registration is not finished until a form is completed in full, the documents are uploaded, and the tuition is paid in full for each student.
Registration must be paid in full before your child attends summer camp.

Instructions

Registration Form

If you are returning to add another student, you may have to refresh the screen to see the form.

Student Name

First Name

Last Name

Student D.O.B.

MM

DD

YYYY

Student Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Student Current School

Student Current Grade

Does your child have an IEP

YES

NO

Maybe

Does your child have any behavioral issues?

Yes

No

Maybe

Please explain your child's behavioral issues:

Are there any other concerns that we should no about?

Parent/Guardian Name

First Name

Last Name

Email

Parent/Guardian Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian Phone

(###)

###

####

Emergency Contact #1 Name

First Name

Last Name

Emergency Contact #1 Phone

(###)

###

####

Emergency Contact #1 Relation to Student

Emergency Contact #2 Name

First Name

Last Name

Emergency Contact #2 Phone

(###)

###

####

Emergency Contact #2 Relation to Student

Elective - Week 1

Elective - Week 2

Elective - Week 3

Elective Week 4

Are you registering more than one student?

Yes

No

Additional Students Names

If you are registering more than one student, please enter first and last names here.