I Can Christian Learning Acadmey

Register for Summer Camp

Please complete the following information in it's entirety. An incomplete application may delay the processing of your request. If you have any questions regarding registration, please contact our office at (770) 627-3424.

Note: Additional information may be requested to complete your application.

Student Information

Select "Add Row" to register multiple students and select "Delete Row" to remove students from the registration form.

Name

DOB

Gender

Grade

Address Information

Enter the home address of the registered students. If different, please submit a separate application for each student.

Home Address
City
State
Zip

Parental Information

Enter the parental information for the registered students.If different, please submit a separate application for each student.

Parent/Guardian
Parent/Guardian Title		Mother Father Other
		If other, please specify relationship
Emergency Contact
Relationship		(e.g. mother, father, sister, etc.)
Emergency Contact #
How did you hear about us?		(e.g. google, yahoo, friend, etc.)

Payment Option

Select the desired camp fee payment option.

	Regular Weekly Payment
	Full Pre-Payment