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Registration Form

Select your school*

Student Information:

Name*

Age*

Grade*

Pickup*

Address*

City*

State*

Zip Code*

Guardian Information:

Guardian Name*

Guardian Email*

Guardian Phone*

Guardian Cell*

Emergency Contact:

Emergency Relationship*

Emergency Phone*

Medical Conditions:

Allergies, Medical Conditions, Medications*

Preferred week(s) for summer camp:

Comment*

*For e-Transfer option please transfer the amount to Info@lecoline.ca and ensure you include the student's name in the message box for proper allocation.

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