Summer Esports Camp

Required

Student Information

Student First Namerequired

Student Middle Name

Student Last Namerequired

Student Date of Birthrequired

Must contain a date in MM/DD/YYYY format

Addressrequired

Cityrequired

Staterequired

Ziprequired

Current Middle Schoolrequired

Session Choice

June 22-25 ($350.00)

July 13-16 ($350.00)

Both Sessions ($700.00)

Grade Entering 2026-27required

7th

8th

Grade Entering 2026-27required

7th

8th

Special Considerations

Medical conditions, accommodations, food allergies, concerns, etc.

Household Information

Primary Household - Parent/Guardian 1

First Namerequired

Last Namerequired

Parent Email Addressrequired

Street Addressrequired

Cityrequired

Staterequired

Ziprequired

Primary Household - Parent/Guardian 2

First

Last

Street Address

City

State

Zip

Secondary Household - Parent/Guardian 1

First

Last

Street Address

City

State

Zip

Secondary Household - Parent/Guardian 2

First

Last

Street Address

City

State

Zip

Primary Emergency ContactrequiredWhich parent/guardian is the primary emergency contact for your student?

Primary Household Parent/Guardian 1

Primary Household Parent/Guardian 2

Secondary Household Parent/Guardian 1

Secondary Household Parent/Guardian 2

Other

Which parent/guardian is the primary emergency contact for your student?

Phone Numberrequired

Secondary Emergency ContactWhich parent/guardian is the secondary emergency contact for your student?

Primary Household Parent/Guardian 1

Primary Household Parent/Guardian 2

Secondary Household Parent/Guardian 1

Secondary Household Parent/Guardian 2

Other

Which parent/guardian is the secondary emergency contact for your student?

Other contact info

Name, Address, Phone Number, Email Address

Photo/Video ReleaserequiredI give consent for my child's image to be used in Summer Session promotions.

Yes

I give consent for my child's image to be used in Summer Session promotions.

Payment

Payment Information

Please select a payment typerequired

Credit Card

Billing Addressrequired

Address

City

State/Province

Country

Zip/Postal Code

Cardholder Namerequired

First

Last

Expirationrequired

Month

Year