Summer Camp Registration

Number of Attendees you are registering? Primary Parent or Guardian First Name: Primary Parent or Guardian Last Name: Relationship to Child: Primary Parent or Guardian Email: Primary Parent or Guardian Phone: Best time to reach you by phone? Parent or Guardian preferred language? Child's Primary Address: City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico U.S. Minor Outlying Islands Virgin Islands Armed Forces Americas Armed Forces Europe, the Middle East, an Armed Forces Pacific Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Territory Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Zip: - Zip Suffix Secondary Parent or Guardian First and Last Name Secondary Parent/Guardian Relationship to Child Secondary Parent or Guardian Email: Secondary Parent or Guardian Phone: How did you find out about Life Lab Camp? Life Lab Email Life Lab social media (Instagram/Facebook) School (teacher, flyer or newsletter) School field trip to Life Lab Friend or family referral Summer camp directory/website Google search Flyer around town Community event at Life Lab Housing Matters Welcoming Network County Park Friends Walnut Avenue Women's Center Other If you selected "Other" please share how Select the updates you'd like to receive from Life Lab If you have a coupon, please enter code here (case-sensitive): Relation of Registrant to Attendees:   Same Household Same Company