Summer Camp Application

Monday, July 12 at 09:00 AM - Documenting Downtown Raleigh

Monday, July 12 at 09:00 AM - Sports and Spirituality in Pursuit of Human Happiness – A Design-Thinking Approach

Monday, July 12 at 09:00 AM - The Art of Songwriting

Contact Email (for registration confirmation)?

Contact First Name

Please fill out the following using the camper's information, not the person submitting the form.

Camper's First Name

Camper's Last Name

Camper's Birthdate

Camper's Social Security Number (Camp fees may be tax deductible; SSN required to send tax form at end of year.)

Camper's Email Address

Camper's Mobile Phone Number

Camper's Mailing Address

Country

Street

City

Region

Postal Code

What year in school?

Camper's T-shirt size?

Will the camper need to park on campus daily while attending camp?

Does the Camper have any food or allergy restrictions?

Please describe in detail their medical conditions

Please describe in detail all food allergens or restrictions

Does the Camper have any medical conditions?

Does the camper require any medications to be taken while at camp?

Please list all medications that need to be taken while at camp

Does the Camper need any special accommodations?

Please describe the special accommodations needed in detail

Emergency Contact #1

Please provide information for the individual we can contact in case of an emergency during the program.

Emergency Contact First Name?

Emergency Contact Last Name?

Mobile Phone Number

Relationship to the camper

Please describe the relationship to the camper

Is Emergency Contact #1 a legal guardian of the camper?

Emergency Contact #2

Please provide information for the individual we can contact in case of an emergency during the program.

Emergency Contact #2 First Name?

Emergency Contact #2 Last Name?

Mobile Phone Number
(different than Emergency Contact #1)

Relationship to the camper

Please describe the relationship to the camper

Is Emergency Contact #2 a legal guardian of the camper?

Are either of the Emergency Contacts employed by William Peace University?

How did you hear about WPU Summer Camps? Check all that apply.

Please identify how you heard about the WPU Summer Camps