LA CANADA CAMPUS REGISTRATION FORM
Parent Information
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Family Address
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City
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State
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Zip
*
Mother's First Name
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Mothers Last Name
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Mother's Phone #
*
Mother's Cell #
Father's First Name
Father's Last Name
Father's Home #
Father's Cell #
*
Mother's Email
*
Re-enter your Email
Father's Email
Re-Enter your Email
Would you like to receive camp updates?
Emergency Information
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Emergency Contact
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Emergency Phone #
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Family Doctor
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Doctors Phone #
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Authorized Pick-Up
How did you hear about us?
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Select one or more!
I am a Returning Camper
Friend
Google Search
Yahoo Search
Pasadena Now!
LA Parent
Fence Banner
Camp Fair
Flyer from School
School Ad
Newspaper or Magazine
Enrichment Guide
Pole Flyer
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What newspaper or magazine did you see us in?
La Canada Sun
Pasadena Outlook
Arroyo Monthly
Pasadena Weeky
Pasadena Magazine
How many campers would you like to enroll at Cooking Camp?
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How many campers are you enrolling?
1
2
3
*
Indicates Response Required