Summer Camp Registration

Capoeira Summer Camp Registration Form

* Indicates required field

Child's Name *

First

Last

Age *

1 Parent/Guardian Name *

Email *

Phone *

2 Parent/Guardian Name *

Email *

Phone *

Emergency Contact Name *

Emergency Contact Phone *

Relationship to Child *

Dietary Allergies or Special Dietary Needs *

Does your child have any physical/developmental challenges? If yes, please explain *

Camp Payment Method *

Check - made out to ICAF Seattle Paypal Scholarship

Submit