Civic Heroes Summer Camp Application Form

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Civic Heroes Summer Camp Application Form

Hosted by
The Office of Civic Engagement at Troy University

Register each participant separately.

Name of Camper*

First Name

Last Name

Current incoming grade*

4th Grade 5th Grade 6th Grade

School attended:*

Camper's T-shirt size*

Are there any medical conditions, allergies or dietary restrictions?

Spaces are limited for this camp experience. We ask that campers commit to attending the camp in its entirety. Please let us know if there is any reason your child would be unable to participate during the dates above. (vacation, etc.)

Parent/Guardian Information

Name of Parent/Guardian*

First Name

Last Name

Parent/Guardian Phone Number*

Alternate Parent/Guardian Phone Number

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Parent/Guardian Email Address*

Confirm Parent/Guardian Email Address *

How did you hear about us?*

A friend Facebook My child's school

Other:

Payment

Camp Fee to be paid today* $

How would you like to pay?*

Credit Card I have a scholarship

Scholarship Code*

Name on Card*

First Name

Last Name

Billing Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Credit Card*

Data Collection and Usage Acknowledgement*

I acknowledge that I am opting in to permit the collection of this data by the University for the purpose(s) indicated.

Learn more about our information policies and how we use data.