Camp Get Right — Bread Winners

camp get right registration Form

Student Name

First Name

Last Name

Student Email Address

Phone Number

Birthday (xx/xx/xxxx)

Grade

School

Parent / Guardian #1 Name

Parent / Guardian #1 Email

Parent / Guardian #1 Phone Number

Parent / Guardian #2 Name

Parent / Guardian #2 Email

Parent / Guardian #2 Phone Number

Dietary Restrictions

*It is okay not to attend all four sessions. Though we strongly encourage this for student improvement.*

Is The Student A Current Big Brother/Big Sister Participant?