Spring Break IMPACT Camp
April 2-6, 2018 
 
 
OUR SPRING BREAK REGISTRATION IS NOW CLOSED!
THANK YOU FOR YOUR INTEREST.... CHECK BACK FOR 2019! 
Your Email:
 *
Student First Name
 *
Student Last Name:
 *
Gender
 *
Student's Cell:
 *
Student's Home #:
 
Parent/Guardian Full Name:
 *
Parent/Guardian Email:
 *
Parent/Guardian Cell #:
 *
Parent/Guardian Work #:
 
Parent/Guardian Full Name:
 
Parent/Guardian Email:
 
Parent/Guardian Cell #:
 
Parent/Guardian Work #:
 
Mailing Address:
 *
City:
 *
State:
 *
Zip:
 *
School Name:
 *
County of School Attending 2017-2018:
 *
Food Restrictions
 
Allergies (list all)
 
Medical Conditions:
 
Preferred Hospital:
 
Age as of April 1, 2018
 *
Please select the camp which you/your student will be attending:
Wake County camp (April 2-6, 2018)
How did you hear about the Spring Break IMPACT Camp?
 *
Verification Code:
Insert above code:
 * Required


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