Spring Break Enrollment Form – SEACAMP San Diego

Date Form Spring Break

Student First Name *

Student Last Name

Student Gender *

Male

Female

Date of Birth *

Student Grade *

Parent/Guardian First & Last Name

Parent/Guardian Email

Siblings or Friends to be grouped with

Every effort is made to accommodate requests. We will contact you if we are NOT able to accommodate.

Who referred you or where did you hear about us?

Click Here to view Referral Program

Has student previously attended SEACAMP San Diego? *

Yes

What program did your student last attend and when?

Additional Notes

On behalf of above student and myself, I agree to the following statement

I have read and agree to all Terms and Conditions. Further, I have read and agree to the Cancellation Polices for this program.

If you are human, leave this field blank.