Wildcat Summer Academy Registration

Student Information

Student First Name

Student Last Name

Student Mailing Address

Country

Street

City

Region

Postal Code

Student Birthdate

Student Gender

Female

Male

Student Email Address

Student Phone #

Event Information

Student T-Shirt Size

Student Dietary Restrictions

Student Grade Level - During the 2022-2023 school year

Student Ethnicity

Special Accommodations

How did you find out about the Wildcat Summer Academy?

Name of friend who referred you (if applicable)

Is there anything else we should know?

Parent Information

Parent/Guardian Full Name

Parent/Guardian Phone #

Parent/Guardian Email Address

Primary Emergency Contact

First Name

Last Name

Emergency Contact Phone #

Relationship of Emergency Contact to Attendee

Alternative Emergency Contact

First Name

Last Name

Alternative Emergency Contact Phone #

Relationship of Alternative Emergency Contact to Attendee