Registration Mosaic Camp

2023 Camper Registration – SPARK! Build—Mosaic

August 7 – August 18 (Two weeks), Monday – Friday, 9 a.m. – 3 p.m. Ages: Middle and High School

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Student's Information

Student's Name*
MM slash DD slash YYYY
SNAP Participant?*
Student's Address*

Parent/Guardian's Information

Parent/Guardian's Name*

Emergency Information

Emergency Contact's First Name*
Max. file size: 300 MB.

Photography/Media Acknowledgment

BY ACKNOWLEDGING AND TYPING MY NAME BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
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